MEDICARE: JEFFREY DUANE MOORE I SPECIALIST

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	1744P3200X	Prosthetics Case Management	054658	OH

General Provider Information

NPI Number	:	1093599318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DUANE MOORE I SPECIALIST

Provider Business Mailing Address
First Line	:	PO BOX 19576
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-0576
Country	:	US
Telephone Number	:	513-646-5126
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 SHORT VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2016
Country	:	US
Telephone Number	:	513-646-5126
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

Similar Medicare Providers

1295519502 — BFI BARBER AND BEAUTY SALON LLC
Practice Location Address:

2601 SHORT VINE ST # 45219
CINCINNATI, OH
45219-2016

Practice Phone: 513-646-5126
Practice Fax:

1750315313 — KARIN S BIERBRAUER M.D.
Practice Location Address:

3333 BURNET AVE , ML 2016
CINCINNATI, OH
45229-3026

Practice Phone: 513-636-4726
Practice Fax: 513-636-2808

1538194329 — KERRY R CRONE M.D.
Practice Location Address:

3333 BURNET AVE ML 2016
CINCINNATI, OH
45229-3026

Practice Phone: 513-636-4726
Practice Fax: 513-636-2808

1780609131 — DR. FRANCESCO T. MANGANO D.O
Practice Location Address:

3333 BURNET AVE , MLC 2016
CINCINNATI, OH
45229

Practice Phone: 513-636-4726
Practice Fax: 513-636-2808

1457408338 — CHARLES BRYCE STEVENSON MD
Practice Location Address:

3333 BURNET AVE., ML 2016 , CINCINNATI CHILDREN'S HOSPITAL
CINCINNATI, OH
45229-3039

Practice Phone: 513-636-4726
Practice Fax: 513-636-2808

1265588925 — DR. SUDHAKAR VADIVELU D.O
Practice Location Address:

3333 BURNET AVE , MLC-2016
CINCINNATI, OH
45229-3026

Practice Phone: 513-636-5333
Practice Fax:

Directions to “ JEFFREY DUANE MOORE I SPECIALIST” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.