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Individual
MR. ROBERT L MOORE
Active
Individual
MR. ROBERT L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICENSED ELIGIBLE ME
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0058230
—
IA
01
—
05823
MEDICARE
IA
Enumeration date
12/18/2006
Last updated
10/10/2007
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