Individual
DR. JACOB ROBERT MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5841 S MARYLAND AVE RM L539, CHICAGO, IL 60637-1447
(773) 702-9500
Mailing address
100 E 14TH ST APT 803, CHICAGO, IL 60605-3666
(815) 988-3623
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
125066516
IL
Other
Enumeration date
06/14/2015
Last updated
06/14/2015
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