Provider Demographics
NPI:1497901029
Name:MOORE, ANTHONY ALLEN (PA)
Entity Type:Individual
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First Name:ANTHONY
Middle Name:ALLEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:695 US HIGHWAY 46
Mailing Address - Street 2:STE 400A
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1568
Mailing Address - Country:US
Mailing Address - Phone:973-894-1265
Mailing Address - Fax:888-972-6480
Practice Address - Street 1:4215 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2206
Practice Address - Country:US
Practice Address - Phone:855-582-7747
Practice Address - Fax:888-972-4761
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9104697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBJ031XOtherQSS SCS PTAN