Provider Demographics
NPI:1962480103
Name:MOORE, RICHARD BENJAMIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BENJAMIN
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:BENJAMIN
Other - Last Name:MOORE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 DELACY DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-9309
Mailing Address - Country:US
Mailing Address - Phone:828-697-0754
Mailing Address - Fax:
Practice Address - Street 1:22 DELACY DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-9309
Practice Address - Country:US
Practice Address - Phone:828-697-0754
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6628208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology