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Individual

WISTAR MOORE III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
801 E 6TH ST STE 307, PANAMA CITY, FL 32401-3663
(850) 785-9559
(850) 608-6423
Mailing address
4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623
(904) 450-6063
(904) 539-4091

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME64685
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
375218600
FL
Enumeration date
06/29/2006
Last updated
03/01/2022
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