Provider Demographics
NPI:1598756504
Name:MOON, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8901 WISCONSIN AVE BLDG 17
Mailing Address - Street 2:ATTN: MEDICAL STAFFING AND PRIVILEGES OFFICE
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-319-9176
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE BLDG 17
Practice Address - Street 2:ATTN: MEDICAL STAFFING AND PRIVILEGES OFFICE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-319-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-12-01
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Provider Licenses
StateLicense IDTaxonomies
HI11846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine