Individual
JASON WAYNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT/ATC
Contact information
Practice address
315 S MISSOURI ST, JACKSON, MO 63755-2000
(573) 837-5960
Mailing address
175 MARK AVE, JACKSON, MO 63755-8437
(573) 837-5960
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2009029675
MO
Other
Enumeration date
01/14/2010
Last updated
09/06/2024
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