Provider Demographics
NPI:1710206875
Name:MOORE, BRANDON JAY (APA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JAY
Last Name:MOORE
Suffix:
Gender:M
Credentials:APA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 PENNSYLVANIA AVENUE
Mailing Address - Street 2:WHITE HOUSE MEDICAL UNIT
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-0000
Mailing Address - Country:US
Mailing Address - Phone:202-757-2476
Mailing Address - Fax:
Practice Address - Street 1:1600 PENNSYLVANIA AVE NW
Practice Address - Street 2:WHITE HOUSE MEDICAL UNIT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20500-0003
Practice Address - Country:US
Practice Address - Phone:202-757-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant