NPIMap

Organization Active NPI

Live Well M.D.

  • Preferred Provider Organization
  • Jacksonville, FL
National Provider Identifier
1992019640
Registry record updated Aug 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
LIVE WELL M.D.
Practice address
11512 Lake Mead Ave
Building 521
Jacksonville, FL 32256-9680
Phone
(904) 807-9747
Fax
(904) 807-9746
NPI assigned
Aug 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2010

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

Authorized official

Name
Alex Moore, M.D.
Title
Doctor
Phone
(904) 807-9747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

11512 Lake Mead Ave
Building 521
Jacksonville, FL 32256-9680

Mailing address

11512 Lake Mead Ave
Building 521
Jacksonville, FL 32256-9680
Phone (904) 807-9747

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280880000000",
    "number": "1992019640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "BUILDING 521",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569680",
            "telephone_number": "904-807-9747",
            "fax_number": "904-807-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "BUILDING 521",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569680",
            "telephone_number": "904-807-9747",
            "fax_number": "904-807-9746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE WELL M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-04",
        "last_updated": "2010-08-04",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "904-807-9747",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; 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.