MEDICARE: DR. JOLENE CHRISTIE MOORE M.D.

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	2084P0800X	Psychiatry Physician	M8191	TX

General Provider Information

NPI Number	:	1538330436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOLENE CHRISTIE MOORE M.D.

Provider Business Mailing Address
First Line	:	8231 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3356
Country	:	US
Telephone Number	:	210-629-1191
Fax Number	:	210-547-9236

Provider Business Practice Location Address
First Line	:	8231 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3356
Country	:	US
Telephone Number	:	210-629-1191
Fax Number	:	210-547-9236

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

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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