Brenda K Moore Do Pa | |
1003 College Blvd W Suite #2 Niceville FL 32578-1068 | |
(850) 678-0443 | |
Not Available |
Full Name | Brenda K Moore Do Pa |
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Speciality | Clinic/Center |
Location | 1003 College Blvd W, Niceville, Florida |
Authorized Official Name and Position | Brenda Kay Moore (PRESIDENT) |
Authorized Official Contact | 8326861965 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Brenda K Moore Do Pa 1003 College Blvd W Suite #2 Niceville FL 32578-1068 Ph: (850) 678-0443 | Brenda K Moore Do Pa 1003 College Blvd W Suite #2 Niceville FL 32578-1068 Ph: (850) 678-0443 |
NPI Number | 1255733986 |
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Provider Enumeration Date | 09/25/2014 |
Last Update Date | 09/25/2014 |
Medicare PECOS PAC ID | 7618299280 |
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Medicare Enrollment ID | O20141210000768 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255733986 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | OS 12957 (Florida) | Primary |
Provider Name | Brenda Kay Moore |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1275824120 PECOS PAC ID: 3678895232 Enrollment ID: I20141210000979 |
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