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Individual

JEFFREY D MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
860 OMNI BLVD, SUITE #203, NEWPORT NEWS, VA 23606-4237
(757) 327-0657
(757) 327-0658
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606-4430
(757) 232-8777
(757) 232-8866

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101040065
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010195446
VA
01
1820272
ANTHEM
VA
01
186495
ANTHEM
VA
01
P00294853
RR/MEDICARE
Enumeration date
11/09/2005
Last updated
08/18/2011
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