Provider Demographics
NPI:1801896980
Name:MOON, ROBERT H (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:MOON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:309 SAINT LUKES DR
Mailing Address - Street 2:MONTGOMERY EAST FAMILY PRACTICE PC
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7109
Mailing Address - Country:US
Mailing Address - Phone:334-272-0066
Mailing Address - Fax:334-272-5015
Practice Address - Street 1:309 SAINT LUKES DR
Practice Address - Street 2:MONTGOMERY EAST FAMILY PRACTICE PC
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7109
Practice Address - Country:US
Practice Address - Phone:334-272-0066
Practice Address - Fax:334-272-5015
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AL15530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
82737Medicare ID - Type Unspecified
E19938Medicare UPIN