Individual
JONATHAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431
(270) 825-6688
(270) 825-7266
Mailing address
2501 KENTUCKY AVE, PADUCAH, KY 42003-3813
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49744
KY
Other
Enumeration date
05/13/2014
Last updated
06/13/2018
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