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General NPI Number Information
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NPI Number | 1982844858
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Entity Type | Organization
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Legal Business Name | JACOB J MOORE MD PA
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 900 MORGAN AVE
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City | CORPUS CHRISTI
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State | TX
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Zip | 78404-2028
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Country | US
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Telephone | 361-888-4288
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Fax | 361-888-4253
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Provider Business Mailing Address
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Address Line | PO BOX 3827
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City | CORPUS CHRISTI
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State | TX
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Zip | 78463-3827
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Country | US
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Telephone | 361-888-4288
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Fax | 361-888-4253
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB JACKSON MOORE
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Credential | MD
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Telephone | 361-888-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M4373
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License Number State | TX
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