Provider Demographics
NPI:1598050064
Name:MOORE, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:MOORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2571
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7420
Practice Address - Country:US
Practice Address - Phone:904-886-2251
Practice Address - Fax:904-886-7151
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2024-01-26
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Provider Licenses
StateLicense IDTaxonomies
CODR.0060237208600000X
SC91477208600000X
FLME166267208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery