Provider Demographics
NPI:1578007761
Name:MOORE, JOHN JAMES
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4960
Mailing Address - Country:US
Mailing Address - Phone:308-464-0824
Mailing Address - Fax:
Practice Address - Street 1:3830 HIGGINS ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4960
Practice Address - Country:US
Practice Address - Phone:308-464-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMP00179558171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMP00179558OtherMASTER PLUMBER