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NPI Code Detail

MEDICARE: JEFFREY D MOORE MD

MEDICARE:   JEFFREY D 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
1207X00000XOrthopaedic Surgery Physician0101040065VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00294853OTHERRR/MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1186495OTHERVAANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31820272OTHERVAANTHEM

General Provider Information

NPI Number : 1023099702
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY D MOORE MD
Provider Business Mailing Address
First Line : 860 OMNI BLVD
Second Line : SUITE 303
City : NEWPORT NEWS
State : VA
Zip : 23606-4430
Country : US
Telephone Number : 757-232-8777
Fax Number : 757-232-8866
Provider Business Practice Location Address
First Line : 860 OMNI BLVD
Second Line : SUITE #203
City : NEWPORT NEWS
State : VA
Zip : 23606-4237
Country : US
Telephone Number : 757-327-0657
Fax Number : 757-327-0658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 08/18/2011

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Directions to “ JEFFREY D MOORE MD” Practice Location

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