Provider Demographics
NPI:1518093673
Name:MOORE, ROBERT DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11975 MORRIS ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4493
Mailing Address - Country:US
Mailing Address - Phone:770-475-4499
Mailing Address - Fax:877-509-0690
Practice Address - Street 1:11975 MORRIS ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4493
Practice Address - Country:US
Practice Address - Phone:770-475-4499
Practice Address - Fax:877-509-0690
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045300207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00799015AMedicaid
GA16BDSKBMedicare ID - Type Unspecified
GAG73720Medicare UPIN