Individual
JACOB E MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
GSMC - EMERGENCY DEPARTMENT, 235 NORTH PEARL ST, BROCKTON, MA 02301
(508) 427-3000
Mailing address
BMCHS PROVIDER ENROLLMENT, 960 MASSACHUSETTS AVE FLR 2, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
125-059970
IL
207P00000X
Emergency Medicine Physician
Primary
258476
MA
207RB0002X
Obesity Medicine (Internal Medicine) Physician
90000429
MA
Other
Enumeration date
06/20/2011
Last updated
05/12/2026
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