MEDICARE: JAMES R 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	207R00000X	Internal Medicine Physician	35-04-9195	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689650236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R MOORE M.D.

Provider Business Mailing Address
First Line	:	4885 OLENTANGY RIVER RD
Second Line	:	SUITE 1-10
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1952
Country	:	US
Telephone Number	:	614-268-6555
Fax Number	:	614-457-5706

Provider Business Practice Location Address
First Line	:	4885 OLENTANGY RIVER RD
Second Line	:	SUITE 1-10
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1952
Country	:	US
Telephone Number	:	614-268-6555
Fax Number	:	614-457-5706

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	01/26/2016

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