Individual
DR. JONATHAN E MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
117 TRADEPARK DR, SOMERSET, KY 42503-3428
(606) 679-2773
(606) 679-4626
Mailing address
117 TRADEPARK DR, SOMERSET, KY 42503-3428
(606) 679-2773
(606) 679-4626
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00269
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80000243
—
KY
Enumeration date
03/08/2006
Last updated
10/29/2007
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