Basic Information
| Provider Information | |||||||||
| NPI: | 1194795849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BRYAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 CIRCLE VIEW DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEW HOPE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078451628 | ||||||||
| FaxNumber: | 7074453710 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 DOLBEER AVE | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074455431 | ||||||||
| FaxNumber: | 7074453710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 10/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD425429 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | A45979 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 101227147 | 05 | PA | MEDICAID |