Individual
SUSAN S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6271 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32217-2523
(904) 633-0460
(904) 633-0461
Mailing address
5396 HIDDEN GARDENS DR, JACKSONVILLE, FL 32258-4201
(904) 553-4644
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME92420
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275686200
—
FL
Enumeration date
10/11/2006
Last updated
12/27/2011
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