Healthcare Provider Details

I. General information

NPI: 1760561252
Provider Name (Legal Business Name): JAMES BILL MOORE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5903 RIDGEWOOD RD STE 340
JACKSON MS
39211
US

IV. Provider business mailing address

5903 RIDGEWOOD RD STE 340
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-899-3340
  • Fax: 601-899-3343
Mailing address:
  • Phone: 601-899-3340
  • Fax: 601-899-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number08023
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: