Provider Demographics
NPI:1194795849
Name:MOORE, JAMES BRYAN III (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYAN
Last Name:MOORE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6801 CIRCLE VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938
Mailing Address - Country:US
Mailing Address - Phone:707-845-1628
Mailing Address - Fax:707-445-3710
Practice Address - Street 1:2700 DOLBEER AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-445-5431
Practice Address - Fax:707-445-3710
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4254292085R0202X
CAA459792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101227147Medicaid
PAA79168Medicare UPIN
PA101227147Medicaid