Individual
JONATHAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4301 W MARKHAM ST # 556, LITTLE ROCK, AR 72205-7101
(501) 603-1595
Mailing address
6925 COBBLESTONE WAY N, MOBILE, AL 36608-4484
(251) 648-9702
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/30/2018
Last updated
03/30/2018
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