Provider Demographics
NPI:1700041894
Name:MOORE, JANE ANN LAMPTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE ANN
Middle Name:LAMPTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 POPLAR BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2117
Mailing Address - Country:US
Mailing Address - Phone:601-331-0176
Mailing Address - Fax:
Practice Address - Street 1:1622 POPLAR BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2117
Practice Address - Country:US
Practice Address - Phone:601-985-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine