Provider Demographics
NPI:1023014008
Name:MOORE, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIVER NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1803
Mailing Address - Country:US
Mailing Address - Phone:254-968-6051
Mailing Address - Fax:254-968-4204
Practice Address - Street 1:150 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1803
Practice Address - Country:US
Practice Address - Phone:254-968-6051
Practice Address - Fax:254-968-4204
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE04475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN160023077OtherRAILROAD MEDICARE
TX814762OtherBCBS PROVIDER NUMBER
TX101877201Medicaid
TX70490001OtherUNITED HEALTHCARE PROV NO
TX119780100OtherFIRST CARE PROVIDER NUMBE
TX2462125003OtherCIGNA PROVIDER NUMBER
TX4458949OtherAETNA PROVIDER NUMBER
TX4458949OtherAETNA PROVIDER NUMBER
TX119780100OtherFIRST CARE PROVIDER NUMBE