Provider Demographics
NPI:1952301517
Name:JIM J MOORE MD, PA
Entity Type:Organization
Organization Name:JIM J MOORE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:501-664-4560
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-664-4560
Mailing Address - Fax:501-661-1707
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:STE 305
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-4560
Practice Address - Fax:501-661-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC2528207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D04798Medicare UPIN
53739Medicare ID - Type Unspecified