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Individual

JONAS O MOEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
36065 SANTA FE AVE, FORT CAVAZOS, TX 76544-4752
(254) 287-1866
(254) 618-1004
Mailing address
36065 SANTA FE AVE, CAFBHS 3RD FLOOR, FORT CAVAZOS, TX 76544
(254) 287-1866
(254) 618-1004

Taxonomy

Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
H6444
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0002LP
BC/BS
TX
05
041249603
TX
01
162008
VALUE OPTIONS
TX
Enumeration date
08/15/2006
Last updated
06/13/2025
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