Provider Demographics
NPI:1457444275
Name:MOORE, HEZEKIAH N (MD)
Entity Type:Individual
Prefix:DR
First Name:HEZEKIAH
Middle Name:N
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1703 TERMINO AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2128
Mailing Address - Country:US
Mailing Address - Phone:562-498-4425
Mailing Address - Fax:562-498-4243
Practice Address - Street 1:1703 TERMINO AVE STE 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2128
Practice Address - Country:US
Practice Address - Phone:562-498-4425
Practice Address - Fax:562-498-4243
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G540510Medicaid
CA7809525Medicare UPIN