Provider Demographics
NPI:1275784530
Name:MOORE, JAMES THOMAS (C PED)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:MOORE
Suffix:
Gender:M
Credentials:C PED
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 4462
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-1462
Mailing Address - Country:US
Mailing Address - Phone:910-362-1552
Mailing Address - Fax:910-362-1089
Practice Address - Street 1:2725 OLD WRIGHTSBORO RD STE 2C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-8065
Practice Address - Country:US
Practice Address - Phone:910-362-1552
Practice Address - Fax:910-362-1089
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other