Provider Demographics
NPI:1386735843
Name:MOORE, ROBERT L (EDD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 HATCHER LN STE 160
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4823
Mailing Address - Country:US
Mailing Address - Phone:931-381-3523
Mailing Address - Fax:931-380-3963
Practice Address - Street 1:1503 HATCHER LN STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4823
Practice Address - Country:US
Practice Address - Phone:931-381-3523
Practice Address - Fax:931-380-3963
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3687448OtherMEDICARE-ROBERT L. MOORE
TN3687448OtherMEDICAID-ROBERT L. MOORE
TN0157654OtherBCBS-ROBERT L. MOORE
TNP00257346OtherRR MEDICARE PARADIGM
TN3687595Medicaid
TN4106061OtherBCBS - PARADIGM
TN3687595Medicaid