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General NPI Number Information
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NPI Number | 1285907055
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Entity Type | Individual
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Provider Name | JEFFREY RYAN MOORE
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Gender | Male
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 04/16/2016
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-3149
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Fax |
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Provider Business Mailing Address
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Address Line | NAVAL HOSPITAL TWENTYNINE PALMS 1145 STURGIS RD
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92278
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Country | US
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Telephone | 760-830-2082
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Fax | 760-830-5264
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101254499
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License Number State | VA
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