| Doctor Name: | DR. JACK D MOORE |
| NPI Number: | 1104876606 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD, PHD |
| License Number: | 04-17620 |
| Business Practice Address: | 4321 Washington St 5300 Kansas City, MO - 641115961 |
| Business Phone Number: | 8165311234 |
| Business Fax Number: | 8165310737 |
| Mailing Address: | 10701 Nall Ave, Suite 100 OVERLAND PARK |
| State: | KS |
| Postal Code: | 662111231 |
| Phone Number: | 9133417985 |
| Fax Number: | 9133417988 |
| NPI Enumeration Date: | 05/12/2006 |
| NPI Last Update Date: | 08/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 04-17620 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |