Individual
JACOB W MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
550 S BERETANIA ST STE 601, HONOLULU, HI 96813-2423
(808) 691-8877
(808) 691-8875
Mailing address
550 S BERETANIA ST STE 601, HONOLULU, HI 96813-2423
(808) 691-8877
(808) 691-8875
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN-558
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000245274
HMSA BILLING NUMBER
HI
05
—
55115201
—
HI
Enumeration date
01/04/2007
Last updated
07/21/2022
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