Provider Demographics
NPI:1619062155
Name:MOORE, ALEXANDER GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:GEORGE
Last Name:MOORE
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:11512 LAKE MEAD AVE UNIT 521
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5835
Practice Address - Country:US
Practice Address - Phone:904-807-9747
Practice Address - Fax:904-902-1199
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME94779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC719ZMedicare PIN