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Individual

JASON MOORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
522 NE THOMPSON ST, PORTLAND, OR 97212-3843
(919) 637-4550
Mailing address
522 NE THOMPSON ST, PORTLAND, OR 97212-3843

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23047
OR

Other

Enumeration date
05/12/2017
Last updated
05/12/2017
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