Provider Demographics
NPI:1093599318
Name:MOORE, JEFFREY DUANE I (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DUANE
Last Name:MOORE
Suffix:I
Gender:M
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19576
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-0576
Mailing Address - Country:US
Mailing Address - Phone:513-646-5126
Mailing Address - Fax:
Practice Address - Street 1:2601 SHORT VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2016
Practice Address - Country:US
Practice Address - Phone:513-646-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0546581744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management