Provider Demographics
NPI:1023099702
Name:MOORE, JEFFREY D (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4237
Practice Address - Country:US
Practice Address - Phone:757-327-0657
Practice Address - Fax:757-327-0658
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101040065207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186495OtherANTHEM
VA010195446Medicaid
VA1820272OtherANTHEM
P00294853OtherRR/MEDICARE
P00294853OtherRR/MEDICARE
VA186495OtherANTHEM