Individual
JONATHAN HOUSTON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2300 12TH ST, MERIDIAN, MS 39301-3933
(601) 483-2616
(601) 485-7282
Mailing address
2300 12TH ST, MERIDIAN, MS 39301-3933
(601) 483-2616
(601) 485-7282
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
17674
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03435769
—
MS
01
—
17674
STATE MEDICAL LISCENSE
MS
Enumeration date
09/20/2006
Last updated
07/08/2007
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