Provider Demographics
NPI:1528018769
Name:MOORMAN, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25074
Mailing Address - Street 2:
Mailing Address - City:ST CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00824-1074
Mailing Address - Country:US
Mailing Address - Phone:340-719-4453
Mailing Address - Fax:340-719-4446
Practice Address - Street 1:118 ESTATE MT WELCOME
Practice Address - Street 2:
Practice Address - City:ST CROIX
Practice Address - State:VI
Practice Address - Zip Code:00824
Practice Address - Country:US
Practice Address - Phone:340-719-4453
Practice Address - Fax:340-719-4446
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI11792086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0020950Medicare PIN
H01066Medicare UPIN