Individual
BENJAMIN E MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 SHIRCLIFF WAY, STE 925, JACKSONVILLE, FL 32204-4753
(904) 387-6116
(904) 387-6118
Mailing address
PO BOX 17809, JACKSONVILLE, FL 32245-7809
(904) 387-6116
(904) 387-6118
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME39355
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130000327
RAILROAD MEDICARE
FL
01
—
15663
BCBS
FL
05
—
273404400
—
FL
Enumeration date
11/10/2005
Last updated
01/09/2012
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