Provider Demographics
NPI:1659424679
Name:MOORE, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1508 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7507
Mailing Address - Country:US
Mailing Address - Phone:910-772-9930
Mailing Address - Fax:910-772-9939
Practice Address - Street 1:1508 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7507
Practice Address - Country:US
Practice Address - Phone:910-772-9930
Practice Address - Fax:910-772-9939
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25063207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890215JMedicaid
NC890215JMedicaid
208983BMedicare PIN
NCC85631Medicare UPIN