Glen Moore Jr.

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

2625 S Durango Dr
Apt 201
Las Vegas, NV 89117-2881

Phone

(313) 244-5112

NPI assigned

Jun 14, 2013

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

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": "1371168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371168000000",
    "number": "1801235668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 S DURANGO DR",
            "address_2": "APT 201",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172881",
            "telephone_number": "313-244-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 S DURANGO DR",
            "address_2": "APT 201",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891172881",
            "telephone_number": "313-244-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "GLEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-14",
        "last_updated": "2013-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ernest Leon Moore Jr.
• Evette Marie Moore
• Felicia Moore
• Gabriella Eliza Moore
• George Moore
• Glenda Moore
• Heaven Moore
• Helen Rebecca Moore, BS
• Iris Moore
• Jamaal Lapree Moore

• Rehabilitation Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Rehabilitation Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; 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.