Individual
JEREMY PAUL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A88084
CA
2080P0202X
Pediatric Cardiology Physician
A88084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A880840
—
CA
01
—
1265676274
CCS PANELED
CA
05
—
1265676274
—
CA
Enumeration date
04/22/2009
Last updated
06/08/2013
Update your record
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