Provider Demographics
NPI:1508848375
Name:MOORE, JAMES D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
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 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:276-628-6011
Mailing Address - Fax:276-628-3923
Practice Address - Street 1:227 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2715
Practice Address - Country:US
Practice Address - Phone:276-628-6011
Practice Address - Fax:276-628-3923
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025906207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002074OtherANTHEM
CK3042OtherMDCR RR
TN0101OtherJOHN DEERE
VA1508848375Medicaid
VA006260802Medicaid
C08321OtherMEDICARE GROUP
VA1508848375Medicaid
VAC06181Medicare UPIN
002074OtherANTHEM
CK3042OtherMDCR RR
C08321OtherMEDICARE GROUP
TN0101OtherJOHN DEERE