Individual
DR. JACK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 RESERVOIR RD NW, WASHINGTON, DC 20007-2113
(202) 877-6034
(202) 877-8329
Mailing address
PO BOX 418283, BOSTON, MA 02241-8283
(202) 877-6034
(202) 877-8329
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD19916
DC
207RN0300X
Nephrology Physician
Primary
MD19916
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025615700
—
DC
05
—
042931700
—
MD
05
—
5817889
—
VA
Enumeration date
02/16/2006
Last updated
06/16/2015
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