Individual
MR. JESSE DANIEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
606 W WILBUR MILLS AVE, KENSETT, AR 72082-9051
(501) 742-5697
(870) 347-3492
Mailing address
400 HIGHWAY 64 E, PO BOX 497, AUGUSTA, AR 72006-5150
(870) 347-3300
(870) 347-3492
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E0005
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126445001
—
AR
Enumeration date
03/31/2006
Last updated
02/20/2015
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