Individual
MR. JEFFERY W MOORE
Active
Individual
MR. JEFFERY W MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28087122A
IN
367H00000X
Anesthesiologist Assistant
28087122
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000603596
ANTHEM - TIPTON HOSPITAL
IN
05
—
200345230
—
IN
05
—
200345230A
—
IN
Enumeration date
12/06/2005
Last updated
10/01/2014
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