Individual
KEITH LOUIS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4007 ESTATE DIAMOND RUBY, CHRISTIANSTED, VI 00820-4435
(340) 778-6311
Mailing address
1374 MEADOWS BLVD, WESTON, FL 33327-1804
(954) 288-7860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3389
FL
Other
Enumeration date
06/01/2011
Last updated
06/01/2011
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