Basic Information
| Provider Information | |||||||||
| NPI: | 1528206950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | HAS, BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14840 MILITARY TRL | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334848153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616383110 | ||||||||
| FaxNumber: | 5616383110 | ||||||||
| Practice Location | |||||||||
| Address1: | 14840 MILITARY TRL | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334848153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616383110 | ||||||||
| FaxNumber: | 5616383110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 10/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS2477 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.