MEDICARE: DR. JORDAN A MOORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	26687	WI

General Provider Information

NPI Number	:	1013992619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN A MOORE MD

Provider Business Mailing Address
First Line	:	121 E SILVER SPRING DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4702
Country	:	US
Telephone Number	:	414-964-9030
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 E SILVER SPRING DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4702
Country	:	US
Telephone Number	:	414-964-9030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	02/18/2016

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