Individual
DR. ROBERT L MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5604 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 991-1044
(601) 991-9868
Mailing address
5604 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 991-1044
(601) 991-9868
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18036
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04133520
—
MS
01
—
315954200
DOL FECA PROVIDER #
MS
Enumeration date
11/03/2005
Last updated
04/18/2013
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