Provider Demographics
NPI:1629388293
Name:MOORE, DANIEL LEE JR (ANP- BC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:ANP- BC
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Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:DIABETES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:DIABETES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8722
Practice Address - Fax:617-724-8534
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2258946363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health