Provider Demographics
NPI:1629498282
Name:MOORE, BRIAN EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 STRATFORD LAKES DR UNIT 122
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3476
Mailing Address - Country:US
Mailing Address - Phone:919-260-9997
Mailing Address - Fax:
Practice Address - Street 1:CHERRY HOSPITAL
Practice Address - Street 2:1401 WEST ASH ST
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27512
Practice Address - Country:US
Practice Address - Phone:919-947-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-005652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty