Provider Demographics
NPI:1962612317
Name:MOORE, JOHN D (BC, HIS, ACA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:BC, HIS, ACA
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:J
Other - Last Name:MCGLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HIS
Mailing Address - Street 1:7050 W PALMETTO PARK RD STE 20
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3462
Mailing Address - Country:US
Mailing Address - Phone:561-367-1623
Mailing Address - Fax:561-571-6319
Practice Address - Street 1:7050 W PALMETTO PARK RD STE 20
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3462
Practice Address - Country:US
Practice Address - Phone:561-367-1623
Practice Address - Fax:561-571-6319
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS0002386237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT0988OtherBCBS