Provider Demographics
NPI:1699906925
Name:ROBERT A. MOORE, M.D., INC.
Entity type:Organization
Organization Name:ROBERT A. MOORE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-764-8070
Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3600
Mailing Address - Country:US
Mailing Address - Phone:949-764-8070
Mailing Address - Fax:949-650-4585
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:STE. 202
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-764-8070
Practice Address - Fax:949-650-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43085207RS0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI158AOtherMEDICARE PTAN # CI158A
CACI158AOtherMEDICARE PTAN # CI158A