Provider Demographics
NPI:1831151562
Name:MOON, JEAN M (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:MOON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1840 S STAPLEY DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6681
Mailing Address - Country:US
Mailing Address - Phone:480-969-5999
Mailing Address - Fax:480-926-0852
Practice Address - Street 1:1840 S STAPLEY DR
Practice Address - Street 2:SUITE 131
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6681
Practice Address - Country:US
Practice Address - Phone:480-969-5999
Practice Address - Fax:480-926-0852
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-07-27
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Provider Licenses
StateLicense IDTaxonomies
AZ20256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136441OtherAHCCCS
AZ919828OtherAETNA
AZAZ0344420OtherBLUE CROSS BLUE SHIELD
AZZWCLFM04OtherMEDICARE
AZ136441OtherMERCY CARE
AZ1Z1315OtherHEALTH NET
AZ136441OtherMERCY CARE