Individual
JASON MOORE
Active
Individual
JASON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.326041
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209.007162
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01211517
RAILROAD MEDICARE
IL
Enumeration date
05/29/2008
Last updated
06/19/2019
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