1699906925 NPI number — ROBERT A. MOORE, M.D., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699906925 NPI number — ROBERT A. MOORE, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT A. MOORE, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699906925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 SUPERIOR AVE
Provider Second Line Business Mailing Address:
STE. 202
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-764-8070
Provider Business Mailing Address Fax Number:
949-650-4585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 SUPERIOR AVE
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-764-8070
Provider Business Practice Location Address Fax Number:
949-650-4585
Provider Enumeration Date:
08/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-764-8070

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  G43085 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: G43085 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CI158A . This is a "MEDICARE PTAN # CI158A" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com