Provider Demographics
NPI:1659310373
Name:MOORING, ROBERT FRANKLIN III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:MOORING
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W H SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3763
Mailing Address - Country:US
Mailing Address - Phone:252-757-2663
Mailing Address - Fax:252-317-0829
Practice Address - Street 1:810 W H SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3763
Practice Address - Country:US
Practice Address - Phone:252-757-2663
Practice Address - Fax:252-317-0829
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10-00251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1274070001OtherDME MAC JURISDICTION C
1274070001OtherDME MAC JURISDICTION C
2765914Medicare ID - Type Unspecified