Individual
DR. JACOB JACKSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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