Individual
JEFFREY LEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 WABASH AVE, AKRON, OH 44307-2433
(330) 344-6525
(330) 996-2943
Mailing address
3428 W MARKET ST, STE 103, FAIRLAWN, OH 44333-3339
(330) 344-3583
(330) 869-2074
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35-053478
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0628744
—
OH
01
—
1144401464
PRACTICE LOCATION NPI GROUP NUMBER
OH
01
—
1841239274
MEDICARE NPI GROUP NUMBER
OH
01
—
2774985
MEDICAID GROUP NUMBER
OH
01
—
9338635
MEDICARE GROUP NUMBER
OH
Enumeration date
12/29/2005
Last updated
05/14/2008
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