Individual
DR. JASON L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
45 10TH ST W, SAINT PAUL, MN 55102-1062
(651) 232-3000
Mailing address
27400 FRANKLIN RD, #B707, SOUTHFIELD, MI 48034-2358
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
39945
IA
207P00000X
Emergency Medicine Physician
4301080458
MI
207P00000X
Emergency Medicine Physician
61613
MN
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4301080458
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104715823
—
MI
05
—
104785416
—
MI
05
—
104785425
—
MI
01
—
JM080458
BC/BS OF MI
MI
Enumeration date
03/28/2006
Last updated
11/16/2020
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