Jerry Lee Moore, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

A206180 Issued in CA

Practice address

1351 E Spruce Ave
Fresno, CA 93720-3342

Phone

(559) 432-3303

Fax

(559) 432-1468

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central California Faculty Medical Group, Inc.

  • Internal Medicine Physician
  • Clovis, CA
  • NPI 1992742852
  NPD (past)
• University Faculty Associates, Inc.

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1073911137
  NPD (past)

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396705547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 E SPRUCE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203342",
            "telephone_number": "559-432-3303",
            "fax_number": "559-432-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 E SPRUCE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203342",
            "telephone_number": "559-432-3303",
            "fax_number": "559-432-1468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JERRY",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A206180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A206180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dona Moore
• Dorothy Dora Moore
• Irene Moore, NP
• Jason Leibrandt Moore, DO
• Jennifer Nicole Moore
• Kayla Moore
• Keondra K Moore
• Lisamarie Moore
• Lynn Diane Moore
• Melodie D Moore

• Otolaryngology Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.