Provider Demographics
NPI:1760468250
Name:MOORE, BRIAN EUGENE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EUGENE
Last Name:MOORE
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:27439 MISTFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7776
Mailing Address - Country:US
Mailing Address - Phone:813-929-7753
Mailing Address - Fax:813-827-2129
Practice Address - Street 1:8415 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-1607
Practice Address - Country:US
Practice Address - Phone:813-827-9548
Practice Address - Fax:813-827-5731
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant