Healthcare Provider Details

I. General information

NPI: 1801938980
Provider Name (Legal Business Name): JEAN N MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH ST S
GREAT FALLS MT
59401-3618
US

IV. Provider business mailing address

601 1ST AVE N
GREAT FALLS MT
59401-2510
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6973
  • Fax: 406-791-9277
Mailing address:
  • Phone: 406-454-6973
  • Fax: 406-791-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70366
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: