Individual
JONATHAN ROSS MOORE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
75 S LAFAYETTE ST, MOBILE, AL 36604-1730
(251) 479-3309
Mailing address
75 S LAFAYETTE ST, MOBILE, AL 36604-1730
(251) 479-3309
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
30077
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/27/2006
Last updated
08/31/2017
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