Provider Demographics
NPI:1760561252
Name:MOORE, JAMES BILL JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BILL
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 RIDGEWOOD RD
Mailing Address - Street 2:STE 340
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-899-3340
Mailing Address - Fax:601-899-3343
Practice Address - Street 1:5903 RIDGEWOOD RD
Practice Address - Street 2:STE 340
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-899-3340
Practice Address - Fax:601-899-3343
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08023207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116271Medicaid
MS00116271Medicaid
MS390000078Medicare PIN