Individual
MR. JON G. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
608 OLD ROUTE 66, SAINT ROBERT, MO 65584-3730
(573) 336-5100
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
118222
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE
MO
01
—
P01262378
RR MCR
MO
Enumeration date
10/19/2005
Last updated
03/13/2014
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