Provider Demographics
NPI:1972746089
Name:MOORE, JAMES N (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:MOORE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 3RD STREET WEST
Mailing Address - Street 2:359 MEDICAL GROUP
Mailing Address - City:JBSA-RANDOLPH AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78150
Mailing Address - Country:US
Mailing Address - Phone:210-652-8544
Mailing Address - Fax:
Practice Address - Street 1:221 3RD STREET WEST
Practice Address - Street 2:359 MEDICAL GROUP
Practice Address - City:JBSA-RANDOLPH AFB
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:210-652-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
FLPA9107961363AM0700X
NMPA2016-0009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical