Provider Demographics
NPI:1023114097
Name:MOORE, STEVEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13163 66TH STREET
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773
Mailing Address - Country:US
Mailing Address - Phone:727-228-7000
Mailing Address - Fax:727-223-3614
Practice Address - Street 1:13163 66TH STREET
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-228-7000
Practice Address - Fax:727-223-3614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 100692OtherMEDICAL LICENSE
FL000695700Medicaid
AZH87299Medicare UPIN