Provider Demographics
NPI:1528206950
Name:MOORE, DOUGLAS ROBERT (HAS, BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:MOORE
Suffix:
Gender:M
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14840 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8153
Mailing Address - Country:US
Mailing Address - Phone:561-638-3110
Mailing Address - Fax:561-638-3110
Practice Address - Street 1:14840 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8153
Practice Address - Country:US
Practice Address - Phone:561-638-3110
Practice Address - Fax:561-638-3110
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2477237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist