Individual
JON RICE MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 LOWELL DR SE, SUITE 106, HUNTSVILLE, AL 35801-3754
(256) 535-5964
(256) 535-5963
Mailing address
420 LOWELL DR SE, SUITE 103, HUNTSVILLE, AL 35801-3754
(256) 535-5940
(256) 535-5954
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15098
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000082080
—
AL
01
—
0004123794
AETNA
—
01
—
110031761
RAILROAD MEDICARE
—
01
—
51082080
BLUE CROSS BLUE SHIELD
AL
01
—
631024475
TAX ID
—
Enumeration date
11/18/2005
Last updated
03/15/2013
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