MEDICARE: DR. JESSICA F MOORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	ME179085	FL
2	2086S0122X	Plastic and Reconstructive Surgery Physician	ME179085	FL
3	207V00000X	Obstetrics & Gynecology Physician	390200000X	FL
4	207V00000X	Obstetrics & Gynecology Physician	MD19932	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073149050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA F MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9339
Fax Number	:	239-468-7948

Provider Business Practice Location Address
First Line	:	8925 COLONIAL CENTER DR STE 1000
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7813
Country	:	US
Telephone Number	:	239-343-9339
Fax Number	:	239-468-7948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2020
Last Update Date	:	06/04/2026

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Directions to “ DR. JESSICA F MOORE MD” Practice Location

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