Individual
DANIEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5012
Mailing address
133 HANOVER ST, MADISON, MS 39110-6028
(601) 325-4716
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
T-5729
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/11/2024
Last updated
07/03/2025
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