Provider Demographics
NPI:1245356823
Name:MOORE, NOEL CYRIL (MAPM, BC-HIS, ACA)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:CYRIL
Last Name:MOORE
Suffix:
Gender:M
Credentials:MAPM, BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4104
Mailing Address - Country:US
Mailing Address - Phone:941-755-5535
Mailing Address - Fax:941-756-1000
Practice Address - Street 1:6024 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4104
Practice Address - Country:US
Practice Address - Phone:941-755-5535
Practice Address - Fax:941-756-1000
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2886237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ0326OtherBLUE CROSS BLUE SHIELD