Provider Demographics
NPI:1144361981
Name:JOHN T. MOOR, M.D.,P.A.
Entity type:Organization
Organization Name:JOHN T. MOOR, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:MOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-957-1500
Mailing Address - Street 1:2446 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3809
Mailing Address - Country:US
Mailing Address - Phone:941-957-1500
Mailing Address - Fax:941-957-3059
Practice Address - Street 1:2446 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3809
Practice Address - Country:US
Practice Address - Phone:941-957-1500
Practice Address - Fax:941-957-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061759801Medicaid
FL0744030001Medicare NSC
FLK3261Medicare ID - Type Unspecified
FL09207Medicare PIN