Individual
DR. ERIC S MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5454 HOHMAN AVE, HAMMOND, IN 46320-1931
(219) 932-2300
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02005208A
IN
207P00000X
Emergency Medicine Physician
036-107014
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-107014-4
—
IL
01
—
036107014
BLUE SHIELD
IL
05
—
036107014-1
—
IL
05
—
300013084
—
IN
Enumeration date
07/29/2005
Last updated
06/11/2020
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