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General NPI Number Information
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NPI Number | 1164540712
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Entity Type | Individual
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Provider Name | JONATHAN TAYLORMOORE MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 3023 HAMAKER CT STE 500
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City | FAIRFAX
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State | VA
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Zip | 22031-2241
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Country | US
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Telephone | 703-876-2788
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Fax | 571-776-3190
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Provider Business Mailing Address
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Address Line | 111 MICHIGAN AVE NW WW 1.5, DEPT OF OPHTHALMOLOGY
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City | WASHINGTON, DC
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State | DC
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Zip | 20010-1433
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Country | US
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Telephone | 202-476-3017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0110X
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Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
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License Number | MD035648
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD035648
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License Number State | DC
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