Provider Demographics
NPI:1013984806
Name:MOORE, JEFFREY R (AUD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S WHITE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-0511
Mailing Address - Country:US
Mailing Address - Phone:928-537-3456
Mailing Address - Fax:928-537-3469
Practice Address - Street 1:2600 S WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-0511
Practice Address - Country:US
Practice Address - Phone:928-537-3456
Practice Address - Fax:928-537-3469
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1918237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter