Individual
DR. JEFFREY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1803
(254) 968-6051
(254) 968-4204
Mailing address
150 RIVER NORTH BLVD, STEPHENVILLE, TX 76401-1803
(254) 968-6051
(254) 968-4204
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E04475
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101877201
—
TX
01
—
119780100
FIRST CARE PROVIDER NUMBE
TX
01
—
160023077
RAILROAD MEDICARE
TN
01
—
2462125003
CIGNA PROVIDER NUMBER
TX
01
—
4458949
AETNA PROVIDER NUMBER
TX
01
—
70490001
UNITED HEALTHCARE PROV NO
TX
01
—
814762
BCBS PROVIDER NUMBER
TX
Enumeration date
06/23/2005
Last updated
09/27/2012
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