Individual
DOMINIC MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 HIGHWAY 13 E, BURNSVILLE, MN 55337-6865
(952) 405-9760
Mailing address
8525 HIDDEN RIVER PKWY, TAMPA, FL 33637-1150
(941) 275-5951
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1208270
FL
363A00000X
Physician Assistant
Primary
14579
MN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/17/2021
Last updated
03/02/2026
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