Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD34690 | TN |
NPI | 1023003936 |
---|---|
Provider Name | Jonathan P Moorman |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 03/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88899 | (02) |