Moore, Charles Robert

Moore, Charles Robert is an individual health care provider with primary practice located at 139 Fairfield Dr , Hattiesburg MS 39402-1303. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Moore, Charles Robert can be contacted via phone (601) 450-2417.

Contact Information

Primary practice address
139 Fairfield Dr Hattiesburg MS 39402-1303
Phone: (601) 450-2417
Fax: (601) 450-2434
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X TRN#12298 Florida
Allopathic & Osteopathic Physicians / Urology 208800000X 20677 Mississippi

Profile Details

NPI number 1801058821
LBN Legal business name Moore, Charles Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2008
Last updated Oct 24th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801058821 NPPES
Mississippi MEDICAID 05137554

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