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General NPI Number Information
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NPI Number | 1982821799
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Entity Type | Individual
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Provider Name | THOMAS J MOON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 841 PRUDENTIAL DR STE 280
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8350
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Country | US
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Telephone | 904-202-8550
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Fax | 904-393-7808
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Provider Business Mailing Address
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Address Line | PO BOX 746645
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City | ATLANTA
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State | GA
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Zip | 30374-6645
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME113107
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | DR47006
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | ME113107
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License Number State | FL
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