Provider Demographics
NPI:1053539072
Name:MOORE, JENNIFER DOROTHY (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DOROTHY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3470 BUSKIRK AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4316
Mailing Address - Country:US
Mailing Address - Phone:925-887-5678
Mailing Address - Fax:925-887-5667
Practice Address - Street 1:3470 BUSKIRK AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4316
Practice Address - Country:US
Practice Address - Phone:925-887-5678
Practice Address - Fax:925-887-5667
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98139207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine