Provider Demographics
NPI:1497150015
Name:MOORE, ROBERT (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF SPEECH PATHOLOGY AND AUDIOLOGY
Mailing Address - Street 2:HAHN 1119, UNIVERSITY OF SOUTH ALABAMA
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-0001
Mailing Address - Country:US
Mailing Address - Phone:251-445-9359
Mailing Address - Fax:251-445-9376
Practice Address - Street 1:DEPT OF SPEECH PATHOLOGY AND AUDIOLOGY
Practice Address - Street 2:HAHN 1119, UNIVERSITY OF SOUTH ALABAMA
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-445-9359
Practice Address - Fax:251-445-9376
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist