Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 045300 | GA |
NPI | 1518093673 |
---|---|
Provider Name | Dr. Robert Daniel Moore |
First Address | Alpharetta, GA 30005-4493 |
Second Address | Alpharetta, GA 30005-4493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2007 |
Last Update Date | 24/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00799015A | (05) | GA |
G73720 | (02) | GA |