Provider Demographics
NPI:1689650236
Name:MOORE, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4885 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 1-10
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1952
Mailing Address - Country:US
Mailing Address - Phone:614-268-6555
Mailing Address - Fax:614-457-5706
Practice Address - Street 1:4885 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 1-10
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1952
Practice Address - Country:US
Practice Address - Phone:614-268-6555
Practice Address - Fax:614-457-5706
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-04-9195207R00000X
OH35.049195208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0591908Medicaid
OH0568599Medicare PIN
OH0591908Medicaid
OHH132751Medicare PIN