Healthcare Provider Details

I. General information

NPI: 1306060678
Provider Name (Legal Business Name): JAMES MOORE D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13444 N 32ND ST STE 15
PHOENIX AZ
85032-6091
US

IV. Provider business mailing address

13444 N 32ND ST STE 15
PHOENIX AZ
85032-6091
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-6310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: