Provider Demographics
NPI:1023305109
Name:MOORE, JEFFREY GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 CARING CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4252
Mailing Address - Country:US
Mailing Address - Phone:313-515-9184
Mailing Address - Fax:
Practice Address - Street 1:1433 CARING CT
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4252
Practice Address - Country:US
Practice Address - Phone:313-515-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13887207L00000X
MI5101022877207L00000X
MI5315078778207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology