Richard Bruce Moore, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA0000001279 Issued in TN

Practice address

1907 W Morris Blvd
Suite B
Morristown, TN 37813-3860

Phone

(423) 587-2707

Fax

(423) 587-3224

NPI assigned

Aug 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark R. Doman, M.D. P.C.

  • Primary Care Clinic/Center
  • Bulls Gap, TN
  • NPI 1225115363
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234224000000",
    "number": "1467560631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "BULLS GAP",
            "state": "TN",
            "postal_code": "377110070",
            "telephone_number": "423-235-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 W MORRIS BLVD",
            "address_2": "SUITE B",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378133860",
            "telephone_number": "423-587-2707",
            "fax_number": "423-587-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RICHARD",
        "middle_name": "BRUCE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2009-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA0000001279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Gail Monteith, MD
• Amanda Montgomery, H.I.S.
• Zinamong Monzon-Benavides, DDS
• Edward Herbert Moody Jr., DDS
• Kimberly Moore, ARNP
• Sonya Glyn Moore, M.S. , LADAC II
• Dana Phillips Moreland, FNP
• Dana Morelock
• Jessica A Morelock, OTR/L
• Halie Morgan, BS

• Medical Physician Assistant in Morristown, TN
• Providers in Morristown, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.