Provider Demographics
NPI:1417912833
Name:MOON, JOHN III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5655 WEST SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-599-9600
Mailing Address - Fax:972-599-9696
Practice Address - Street 1:5655 WEST SPRING CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-599-9600
Practice Address - Fax:972-599-9696
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine