Individual
JOHN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5888
(601) 261-3587
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5888
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
19690
FL
208800000X
Urology Physician
Primary
26534
MS
208800000X
Urology Physician
ME124782
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04421823
—
MS
Enumeration date
06/02/2014
Last updated
07/08/2020
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