Individual
DR. JOSE ANTONIO MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 N RITTER AVE, SUITE 120, INDIANAPOLIS, IN 46219-3052
(317) 355-1000
(317) 355-5440
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01074398A
IN
208600000X
Surgery Physician
11014344A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201243820
—
IN
01
—
P01424382
RAIL ROAD PTAN
IN
Enumeration date
07/09/2008
Last updated
11/27/2023
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