Individual
JEREMY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 WYOMING ST, DAYTON, OH 45409-2722
(937) 208-3356
(937) 208-3356
Mailing address
1 WYOMING ST, DAYTON, OH 45409-2722
(937) 208-3356
(937) 208-3356
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.122401
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0095172
—
OH
Enumeration date
04/06/2012
Last updated
11/18/2024
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