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NPI Code Detail

MEDICARE: THOMAS JORDAN MOORE IV

MEDICARE: THOMAS JORDAN MOORE IV
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
1175T00000XPeer SpecialistMPSS-FQMHKDCA

General Provider Information

NPI Number : 1265264030
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS JORDAN MOORE IV
Provider Business Mailing Address
First Line : 200 EDMONDS RD
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94062-3813
Country : US
Telephone Number : 669-245-3248
Fax Number :
Provider Business Practice Location Address
First Line : 200 EDMONDS RD
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94062-3813
Country : US
Telephone Number : 669-245-3248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2024
Last Update Date : 06/12/2026

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Directions to “ THOMAS JORDAN MOORE IV ” Practice Location

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