Doctor Name: | JAMES N MOORE |
NPI Number: | 1972746089 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 208 W D L Ingram Blvd 26 Special Tactics Squadron / Acu Cannon Afb, NM - 881035103 |
Business Phone Number: | 6618021792 |
Business Fax Number: | |
Mailing Address: | 208 W D L Ingram Blvd, 26 Special Tactics Squadron / Acu CANNON AFB |
State: | NM |
Postal Code: | 881035103 |
Phone Number: | 6618021792 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2009 |
NPI Last Update Date: | 12/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |