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NPI Lookup from the NPI Registry — National Provider Identifier Database

Contact Information

THOMAS J MOON JR, MD
841 PRUDENTIAL DR
SUITE 100
JACKSONVILLE, FL32207-8329
 Phone: 904-633-4120
 Fax: 904-633-4111
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Cardiology

2080P0202X 37 Physician/Pediatric Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for THOMAS J MOON JR · (Male)

NPI Number 1982821799
Credentials MD
Entity Individual
Enumeration date 04/20/2007
Last updated 08/14/2012 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
CO License # DR47006
FL License # ME113107
FL Medicaid 005915000
GA Medicaid 003125542A
FL Medicare PIN GH309Z
FL Other 14KY8 BCBS
Hospital affiliation(s)
  • BAPTIST MEDICAL CENTER - (Acute Care)
    800 PRUDENTIAL DR
    JACKSONVILLE, FL 32207
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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