Provider Demographics
NPI:1902167232
Name:MOORE, RICHARD JAMES (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7453
Mailing Address - Country:US
Mailing Address - Phone:904-264-1204
Mailing Address - Fax:904-264-1227
Practice Address - Street 1:1570 ISLAND LN
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7453
Practice Address - Country:US
Practice Address - Phone:904-264-1204
Practice Address - Fax:904-264-1227
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 3229207Q00000X
FLOS 12696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine