Provider Demographics
NPI:1437199494
Name:MOORE, JULIAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4450 S TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3241
Mailing Address - Country:US
Mailing Address - Phone:561-844-9443
Mailing Address - Fax:561-844-1013
Practice Address - Street 1:1100 N PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2129
Practice Address - Country:US
Practice Address - Phone:863-763-7481
Practice Address - Fax:863-763-5920
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015438700Medicaid
FL015438700Medicaid