John B Moore IV, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

0420320 Issued in KS

Practice address

20375 W 151St St
Suite 370
Olathe, KS 66061

Phone

(913) 782-0707

Fax

(913) 782-5813

NPI assigned

Nov 8, 2005

Reactivated

Oct 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312329600000",
    "number": "1316928229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20375 W 151ST ST",
            "address_2": "SUITE 370",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "66061",
            "telephone_number": "913-782-0707",
            "fax_number": "913-782-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20375 W 151ST ST",
            "address_2": "SUITE 370",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "66061",
            "telephone_number": "913-782-0707",
            "fax_number": "913-782-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2011-08-03",
        "deactivation_date": "2005-11-08",
        "reactivation_date": "2006-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "KS",
            "license": "0420320",
            "primary": true
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "KS",
            "license": "0420320",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100205260A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "563754",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "10226021",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Misty Montague, LPC
• Kelsey Lynn Montgomery, PT, DPT
• Carlos Manuel Monzon, MD
• Curtis Alan Moore, MD
• Grace Moore, T-LMSW
• Julia Moore, DPT
• Julia Megan Moore, CSW
• Madysen Moore, PHARMD
• Rhiannon Moore, PSY.D.
• Carter Moravek

• Plastic and Reconstructive Surgery Physician in Olathe, KS
• Providers in Olathe, KS by specialty
• Plastic and Reconstructive Surgery Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.