Provider Demographics
NPI:1669542148
Name:MOORE, RONALD E JR (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 11705
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1705
Mailing Address - Country:US
Mailing Address - Phone:954-797-4220
Mailing Address - Fax:954-440-0340
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 723
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-797-4220
Practice Address - Fax:954-440-0340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87976208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274253500Medicaid
FL71634OtherBCBS
FL71634OtherBCBS
FLI25754Medicare UPIN