Provider Demographics
NPI:1407598295
Name:MOORMAN, JOHN DAVID (MS, BS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:MS, BS
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Mailing Address - Street 1:4836 BELLADONNA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-4608
Mailing Address - Country:US
Mailing Address - Phone:855-864-4322
Mailing Address - Fax:
Practice Address - Street 1:7455 W WASHINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4340
Practice Address - Country:US
Practice Address - Phone:855-864-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic