Provider Demographics
NPI:1760471304
Name:MOORE, KEITH R (DO)
Entity Type:Individual
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First Name:KEITH
Middle Name:R
Last Name:MOORE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:9500 S DADELAND BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2866
Mailing Address - Country:US
Mailing Address - Phone:786-530-3820
Mailing Address - Fax:305-675-3378
Practice Address - Street 1:10800 DYLAN LOREN CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4437
Practice Address - Country:US
Practice Address - Phone:407-277-8665
Practice Address - Fax:407-277-1267
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2022-07-06
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Provider Licenses
StateLicense IDTaxonomies
FLOS6231207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003311800Medicaid
E09608Medicare UPIN
FL003311800Medicaid