Provider Demographics
NPI:1689698763
Name:MOORE, ROBERT GARY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GARY
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:631 ELM ST SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1952
Mailing Address - Country:US
Mailing Address - Phone:541-812-4388
Mailing Address - Fax:541-812-4393
Practice Address - Street 1:631 ELM ST SW
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1952
Practice Address - Country:US
Practice Address - Phone:541-812-4388
Practice Address - Fax:541-812-4393
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-03-15
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Provider Licenses
StateLicense IDTaxonomies
ORMD12176208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology