Individual
KENNETH H MOON JR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2301 EAST 14TH STREET, DES MOINES, IA 50316-1901
(515) 262-0404
(515) 262-0489
Mailing address
2301 E 14TH ST, DES MOINES, IA 50316-1901
(515) 262-0404
(515) 262-0489
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
02033
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447226840
—
IA
05
—
2215236
—
IA
Enumeration date
02/24/2006
Last updated
08/09/2012
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