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NPI Code Detail

MEDICARE: JASON B. MOORE

MEDICARE: JASON B. MOORE
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
1207Q00000XFamily Medicine Physician36696TN

General Provider Information

NPI Number : 1447236450
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON B. MOORE
Provider Business Mailing Address
First Line : PO BOX 699
Second Line :
City : MOUNTAIN HOME
State : TN
Zip : 37684-0699
Country : US
Telephone Number : 423-989-4050
Fax Number : 423-990-3044
Provider Business Practice Location Address
First Line : 208 MEDICAL PARK BLVD
Second Line :
City : BRISTOL
State : TN
Zip : 37620-7343
Country : US
Telephone Number : 423-989-4050
Fax Number : 423-990-3044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 02/06/2019

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