Basic Information
| Provider Information | |||||||||
| NPI: | 1104133370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOOR | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | JOHN F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 SUMNER STREET, SUITE M201 | ||||||||
| Address2: | GUARDIAN ANESTHESIA INC. | ||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813442325 | ||||||||
| FaxNumber: | 7813418544 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 SANDWICH STREET | ||||||||
| Address2: | C/O ANESTHESIA DEPT. | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813442325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2010 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 245114 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207R00000X | 245114 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207LP2900X | 245114 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 261880 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 261880 | MA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.