Individual
BLAKE WALTER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9101 STONY POINT DR., RICHMOND, VA 23235
(804) 330-9105
(804) 287-6119
Mailing address
9101 STONY POINT DR., RICHMOND, VA 23235
(804) 330-9105
(804) 287-6119
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101256077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992903769
HEALTH NET FEDERAL SERVICES
VA
05
—
1992903769
—
VA
01
—
5604405
CIGNA
VA
01
—
7505953
AETNA
VA
Enumeration date
07/03/2007
Last updated
10/28/2020
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