Provider Demographics
NPI:1336620855
Name:MOORE ORTHOPEDICS AND SPORTS MEDICINE, P.A.
Entity Type:Organization
Organization Name:MOORE ORTHOPEDICS AND SPORTS MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-808-4250
Mailing Address - Street 1:4218M ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2866
Mailing Address - Country:US
Mailing Address - Phone:252-808-3100
Mailing Address - Fax:
Practice Address - Street 1:1165 CEDAR POINT BLVD STE M
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-1030
Practice Address - Country:US
Practice Address - Phone:252-808-4440
Practice Address - Fax:252-764-2442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOORE ORTHOPEDICS AND SPORTS MEDICINE, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty