Provider Demographics
NPI:1578724183
Name:MOORE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MOORE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-732-7957
Mailing Address - Street 1:4300 W LAKE MARY BLVD
Mailing Address - Street 2:STE 1010-357
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2060
Mailing Address - Country:US
Mailing Address - Phone:407-732-7957
Mailing Address - Fax:407-732-7925
Practice Address - Street 1:4300 W LAKE MARY BLVD
Practice Address - Street 2:STE 1010-357
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2060
Practice Address - Country:US
Practice Address - Phone:407-732-7957
Practice Address - Fax:407-732-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006387600Medicaid
FL006387600Medicaid
TX352463Medicare PIN