| Moore Medical Group Inc | |
|
4300 W Lake Mary Blvd Ste 1010-357 Lake Mary FL 32746-2060 | |
| (407) 732-7957 | |
| (407) 732-7925 |
| Full Name | Moore Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4300 W Lake Mary Blvd, Lake Mary, Florida |
| Authorized Official Name and Position | Eric Alan Moore (PHYSICIAN) |
| Authorized Official Contact | 4077327957 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Medical Group Inc 4300 W Lake Mary Blvd Ste 1010-357 Lake Mary FL 32746-2060 Ph: (407) 732-7957 | Moore Medical Group Inc 4300 W Lake Mary Blvd Ste 1010-357 Lake Mary FL 32746-2060 Ph: (407) 732-7957 |
| NPI Number | 1578724183 |
|---|---|
| Provider Enumeration Date | 06/17/2008 |
| Last Update Date | 10/09/2023 |
| Medicare PECOS PAC ID | 9638354889 |
|---|---|
| Medicare Enrollment ID | O20110503000436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578724183 | NPI | - | NPPES |
| 006387600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME63176 (Florida) | Primary |
| Provider Name | Laurie A Gerhard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962440461 PECOS PAC ID: 8426073909 Enrollment ID: I20051013000567 |
| Provider Name | Eric A Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316962582 PECOS PAC ID: 1557376761 Enrollment ID: I20060209000133 |
| Provider Name | John M Griggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750384012 PECOS PAC ID: 9537232046 Enrollment ID: I20080716000695 |
| Provider Name | Anastasia Watts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821497371 PECOS PAC ID: 7618197617 Enrollment ID: I20140925000143 |
| Provider Name | Stephanie Sankey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518395086 PECOS PAC ID: 7113242561 Enrollment ID: I20150206001289 |
| Provider Name | Martha Ruder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770950552 PECOS PAC ID: 6305155854 Enrollment ID: I20151022002654 |
| Provider Name | Marie M Collazo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346640356 PECOS PAC ID: 3476863994 Enrollment ID: I20151112000504 |
| Provider Name | Emmanuell M Dickerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336528173 PECOS PAC ID: 0547560831 Enrollment ID: I20151118000333 |
| Provider Name | Nasser Lavaud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205207883 PECOS PAC ID: 0042514226 Enrollment ID: I20160209000868 |
| Provider Name | Rubens L Jean-baptiste |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306217690 PECOS PAC ID: 9537467352 Enrollment ID: I20160412001433 |
| Provider Name | Amy E Rackard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306339320 PECOS PAC ID: 2860741501 Enrollment ID: I20180814002180 |
| Provider Name | Sarah Slone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225501653 PECOS PAC ID: 8022356179 Enrollment ID: I20190214002062 |
| Provider Name | Oluwabusayo Omole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376056341 PECOS PAC ID: 6901228378 Enrollment ID: I20200612002348 |
| Provider Name | Laura Amabile |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336800366 PECOS PAC ID: 3375919012 Enrollment ID: I20221020000923 |
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