Individual
JEFFREY KEITH MOORE
Active
Individual
JEFFREY KEITH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01029516
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109394
ANTHEM
IN
01
—
070005453
RAILROAD
—
05
—
100078540
—
IN
01
—
64755457
KY MEDICAID
KY
Enumeration date
11/30/2006
Last updated
01/08/2013
Update your record
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