Peter Moreno IV, SOIDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

PSC Box 20183
2D Marine Special Operations Battalion
Camp Lejeune, NC 28542-0116

Phone

(910) 440-7704

NPI assigned

Oct 12, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1043595861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PSC BOX 20183",
            "address_2": "2D MARINE SPECIAL OPERATIONS BATTALION",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420183",
            "telephone_number": "910-440-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PSC BOX 20183",
            "address_2": "2D MARINE SPECIAL OPERATIONS BATTALION",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420116",
            "telephone_number": "910-440-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "PETER",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "SOIDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-12",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clifford William Moore, DDS
• Jeremy Moore, CRNA
• Timothy Loren Moore, IDC
• Jeffrey Allen Moos, DDS
• Carol Matzary Morales
• John Angus Morgan
• John Willard Morrison Jr., D.O.
• Wesley Taylor Morrison
• Kaitlyn Brooks Mosteller
• Joy Mozie, NP-C

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.