Provider Demographics
NPI:1790764041
Name:JAN, MOORE HUA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOORE
Middle Name:HUA
Last Name:JAN
Suffix:
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 1:232 S GLADES TRL
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2478
Mailing Address - Country:US
Mailing Address - Phone:850-960-2492
Mailing Address - Fax:
Practice Address - Street 1:350 CRAG RD
Practice Address - Street 2:NAVY DIVING AND SALVAGE TRAINING CENTER
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-7013
Practice Address - Country:US
Practice Address - Phone:850-235-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH94642083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine