Provider Demographics
NPI:1710901533
Name:MOORE, ANTHONY B (PH D)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:B
Last Name:MOORE
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W KENNEDY BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2952
Mailing Address - Country:US
Mailing Address - Phone:813-879-4415
Mailing Address - Fax:
Practice Address - Street 1:3333 W KENNEDY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2952
Practice Address - Country:US
Practice Address - Phone:813-879-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY002459103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist