Provider Demographics
NPI:1265479471
Name:MOORE, JAMES LOVE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOVE
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 600
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-948-6540
Practice Address - Fax:601-326-1501
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-03-27
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Provider Licenses
StateLicense IDTaxonomies
MS12526207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120175Medicaid
MS0120175Medicaid
MS160043434OtherRAILROAD MEDICARE
MSE44590Medicare UPIN
MS0120175Medicaid