Provider Demographics
NPI:1265413389
Name:MOORE, IRIS JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:JEAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8005 FARNAM DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3426
Mailing Address - Country:US
Mailing Address - Phone:402-502-6970
Mailing Address - Fax:402-502-6930
Practice Address - Street 1:8005 FARNAM DR
Practice Address - Street 2:SUITE 204
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3426
Practice Address - Country:US
Practice Address - Phone:402-502-6970
Practice Address - Fax:402-502-6930
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE15436207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE42154126400Medicaid
D05135Medicare UPIN
275739Medicare ID - Type Unspecified