Provider Demographics
NPI:1780786830
Name:MOORE, ROBERT S JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:11657 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5047
Practice Address - Country:US
Practice Address - Phone:865-577-4836
Practice Address - Fax:865-573-8831
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD24149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37066302OtherMEDICARE LEGACY GROUP
TNP00436763OtherRR MEDICARE PIN
TN30769761Medicare PIN
F62664Medicare UPIN