John Douglas Moore, DIVE IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

1004 Hermitage Rd BLDG 1014
Virginia Beach, VA 23459-9100

Phone

(757) 462-3178

NPI assigned

Oct 7, 2016

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": "1475798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1851841449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 HERMITAGE RD BLDG 1014",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234599100",
            "telephone_number": "757-462-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 HERMITAGE RD BLDG 1014",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234599100",
            "telephone_number": "757-462-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOHN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "DIVE IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-07",
        "last_updated": "2016-10-07",
        "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": []
}

• Christine M Moore, ATC
• Courtney Michelle Moore
• Destiny Moore
• Jakia Moore
• Jasmine Moore
• Joyann Moore
• Kathryn Adele Moore, MS, CFY-SLP
• Latisha Moore, LPC, CSAC
• Lisa Moore, RDN, LDN
• Sarah Morris Moore, L.C.S.W.

• Independent Duty Corpsman in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Independent Duty Corpsman in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; 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.