Individual
DR. JACOB JACKSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 MORGAN AVE, CORPUS CHRISTI, TX 78404-2028
(361) 888-4288
(361) 888-4293
Mailing address
PO BOX 3827, CORPUS CHRISTI, TX 78463-3827
(361) 888-4288
(361) 888-4293
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
56146
GA
207W00000X
Ophthalmology Physician
Primary
M4373
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144249277
NPI
TX
05
—
182155501
—
TX
01
—
8W1399
BCBS
TX
01
—
P00338508
RR MEDICARE
TX
Enumeration date
07/19/2006
Last updated
09/02/2022
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