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General NPI Number Information
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NPI Number | 1467243808
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Entity Type | Individual
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Provider Name | MR. JORDAN MICHAEL MOORE
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Gender | Male
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 1807 W SLAUGHTER LN
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City | AUSTIN
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State | TX
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Zip | 78748-6230
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Country | US
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Telephone | 512-282-8967
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Fax |
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Provider Business Mailing Address
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Address Line | 4506 WILD DUNES CT
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City | AUSTIN
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State | TX
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Zip | 78747-1302
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Country | US
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Telephone | 210-912-7763
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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 | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | 547877
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 547877
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License Number State | TX
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