Provider Demographics
NPI:1184776809
Name:MOORE, TERRALL NEAL (DO)
Entity type:Individual
Prefix:
First Name:TERRALL
Middle Name:NEAL
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 1:1110 TIGER TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-7100
Mailing Address - Country:US
Mailing Address - Phone:850-916-5271
Mailing Address - Fax:
Practice Address - Street 1:BAPTIST HOSPITAL
Practice Address - Street 2:1000 WEST MORENO STREET
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32522-7500
Practice Address - Country:US
Practice Address - Phone:850-434-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8926207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine