Provider Demographics
NPI:1982664900
Name:MOORE, ROBERT GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GENE
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 W HENDERSON ST STE 110
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2700
Practice Address - Country:US
Practice Address - Phone:704-633-9441
Practice Address - Fax:704-637-9006
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4841208800000X
NC2012-02376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039416504Medicaid
TXH4841OtherLICENSE
TXE18101Medicare UPIN
8C2727Medicare ID - Type Unspecified