Kerry F. Moore M.D.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

A41582 Issued in CA

Legal business name

KERRY F. MOORE M.D.

Practice address

16049 Tuscola Rd
Suite B
Apple Valley, CA 92307-1319

Phone

(760) 242-4101

Fax

(760) 242-8256

NPI assigned

Nov 17, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kerry F Moore, M.D.

Title

Ceo

Phone

(760) 242-4101

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558435263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16049 TUSCOLA RD",
            "address_2": "SUITE B",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071319",
            "telephone_number": "760-242-4101",
            "fax_number": "760-242-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16049 TUSCOLA RD",
            "address_2": "SUITE B",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071319",
            "telephone_number": "760-242-4101",
            "fax_number": "760-242-8256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY F. MOORE M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-242-4101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A41582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A415820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.