Individual
JODI MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
47 8TH ST W, DICKINSON, ND 58601-3951
(701) 456-3819
(701) 456-3815
Mailing address
47 8TH ST W, DICKINSON, ND 58601-3951
(701) 456-3819
(701) 456-3815
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0303
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00074851
RAILROAD MEDICARE
ND
Enumeration date
01/25/2006
Last updated
07/08/2007
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