MEDICARE: JAMES DILLON MOORE FNP

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	363LF0000X	Family Nurse Practitioner	710553	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	TX	BCBSTX - WHS PS
2	8KB821	OTHER	TX	BCBSTX
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417107905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DILLON MOORE FNP

Provider Business Mailing Address
First Line	:	PO BOX 2078
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-6156
Country	:	US
Telephone Number	:	940-626-1370
Fax Number	:	940-393-0561

Provider Business Practice Location Address
First Line	:	133 N FM 730 UNIT 105
Second Line	:
City	:	BOYD
State	:	TX
Zip	:	76023-3072
Country	:	US
Telephone Number	:	940-433-2151
Fax Number	:	940-433-2366

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	10/31/2019

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