Individual
CHARLES ROBERT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
139 FAIRFIELD DR, HATTIESBURG, MS 39402-1303
(601) 450-2417
(601) 450-2434
Mailing address
139 FAIRFIELD DR, HATTIESBURG, MS 39402-1303
(601) 450-2417
(601) 450-2434
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
20677
MS
390200000X
Student in an Organized Health Care Education/Training Program
TRN#12298
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05137554
—
MS
Enumeration date
06/30/2008
Last updated
10/24/2011
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