Individual
JORDAN EDWARD MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPH
Contact information
Practice address
2280 MARCOLA RD, SPRINGFIELD, OR 97477-2594
(541) 747-4300
(541) 747-0655
Mailing address
2280 MARCOLA RD, SPRINGFIELD, OR 97477-2594
(541) 747-4300
(541) 747-0655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA179905
OR
363AM0700X
Medical Physician Assistant
PA179905
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500715905
—
OR
Enumeration date
09/13/2016
Last updated
06/09/2021
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