Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S03572 | MD |
N | 111NI0013X | Independent Medical Examiner | 503572 | MD |
NPI | 1124266101 |
---|---|
Provider Name | Dr. Jill Moore |
First Address | Bel Air, MD 21014-3978 |
Second Address | Bel Air, MD 21014-3978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 17/03/2014 |