Healthcare Provider Details

I. General information

NPI: 1831151562
Provider Name (Legal Business Name): JEAN M MOON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S STAPLEY DR SUITE 131
MESA AZ
85204-6681
US

IV. Provider business mailing address

1840 S STAPLEY DR SUITE 131
MESA AZ
85204-6681
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-5999
  • Fax: 480-926-0852
Mailing address:
  • Phone: 480-969-5999
  • Fax: 480-926-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20256
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: