Provider Demographics
NPI:1336400639
Name:MOORE, ANDREW J (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2525 COURT DRIVE GASTONIA PHYSICIAN SERVICES, PLLC
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2140
Mailing Address - Country:US
Mailing Address - Phone:704-834-3471
Mailing Address - Fax:
Practice Address - Street 1:2525 COURT DRIVE GASTONIA PHYSICIAN SERVICES, PLLC
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-834-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD252576207P00000X
NC2014-02448207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine