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NPI Code Detail

MEDICARE: JONATHAN P MOORMAN M.D.

MEDICARE: JONATHAN P MOORMAN M.D.
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
1207RI0200XInfectious Disease PhysicianMD34690TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023003936
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN P MOORMAN M.D.
Provider Business Mailing Address
First Line : PO BOX 699
Second Line :
City : MOUNTAIN HOME
State : TN
Zip : 37684-0699
Country : US
Telephone Number : 423-439-7280
Fax Number : 423-979-4134
Provider Business Practice Location Address
First Line : 615 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-8209
Country : US
Telephone Number : 423-930-8337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 01/23/2024

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