Provider Demographics
NPI:1972928703
Name:MOORE, JOEL LEON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:LEON
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOCK
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6202
Mailing Address - Fax:252-758-8333
Practice Address - Street 1:1850 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-413-6202
Practice Address - Fax:252-758-8333
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02487207RS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine