Individual
MARK C MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 MICCOSUKEE RD, TALLAHASSEE MEMORIAL HOSPITAL, TALLAHASSEE, FL 32308-5054
(317) 567-2180
Mailing address
11460 N MERIDIAN ST STE 110, CARMEL, IN 46032-4409
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME65004
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000891184A
—
GA
05
—
259293200
—
FL
Enumeration date
07/14/2006
Last updated
10/05/2010
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