Individual
JORDAN MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-2273
Mailing address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005794RX
OH
363A00000X
Physician Assistant
LE-00026012
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LE-00026012
OHIO MEDICAL BOARD PRESCRIPTIVE AUTHORITY NUMBER
OH
Enumeration date
11/20/2018
Last updated
11/20/2018
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