Provider Demographics
NPI:1487648002
Name:MOON, JAMES FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANK
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1501 W 24TH ST
Mailing Address - Street 2:SUITE A201
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6370
Mailing Address - Country:US
Mailing Address - Phone:928-341-1981
Mailing Address - Fax:928-341-1984
Practice Address - Street 1:1501 W 24TH ST
Practice Address - Street 2:SUITE A201
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6370
Practice Address - Country:US
Practice Address - Phone:928-341-1981
Practice Address - Fax:928-341-1984
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2013-01-23
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AZ17167208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)