Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 57407 | WI |
N | 208200000X | Surgeon | 35.093515 | OH |
N | 208600000X | Surgeon | 35.093515 | OH |
N | 208200000X | Surgeon | 57407 | WI |
N | 208600000X | Surgeon | 57407 | WI |
Y | 2086S0127X | Trauma Surgeon | ME118118 | FL |
NPI | 1407976517 |
---|---|
Provider Name | Ashlee E. Moore |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010462400 | (05) | FL |
HR712X | HFMG FL MEDICARE (01) | FL |
HR712Y | FL MEDICARE (01) | FL |