Moon, Jordan Edward

Moon, Jordan Edward is an individual health care provider with primary practice located at 2280 Marcola Rd , Springfield OR 97477-2594. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Moon, Jordan Edward can be contacted via phone (541) 747-4300.

Contact Information

Primary practice address
2280 Marcola Rd Springfield OR 97477-2594
Phone: (541) 747-4300
Fax: (541) 747-0655
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA179905 Oregon
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA179905 Oregon

Profile Details

NPI number 1770031221
LBN Legal business name Moon, Jordan Edward
Credentials PA-C, MPH
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2016
Last updated Jun 9th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770031221 NPPES
Oregon MEDICAID 500715905

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