Provider Demographics
NPI:1619230554
Name:MOE, JOHN FREDRICK (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDRICK
Last Name:MOE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4235
Mailing Address - Country:US
Mailing Address - Phone:317-770-9316
Mailing Address - Fax:
Practice Address - Street 1:717 SAINT JAMES PL
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4235
Practice Address - Country:US
Practice Address - Phone:317-770-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021541A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine