Randall Jay Moore, M.D., M.P.H., C.P.E

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

M-4332 Issued in ID

Practice address

366MDG/SGPF
90 Hope Drive; BLDG 6000
Mountain Home Afb, ID 83648

Phone

(208) 828-7401

NPI assigned

Dec 7, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1992780597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1338",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836381338",
            "telephone_number": "808-772-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366MDG/SGPF",
            "address_2": "90 HOPE DRIVE; BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "83648",
            "telephone_number": "208-828-7401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1129 Rim Drive",
            "address_purpose": "LOCATION",
            "city": "McCall",
            "state": "ID",
            "postal_code": "83638",
            "country_code": "US",
            "telephone_number": "808-772-0871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RANDALL",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H., C.P.E",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "MT",
            "license": "4463",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "AZ",
            "license": "17958",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "ID",
            "license": "M-4332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Elizabeth Lynch, WHNP-BC
• Thomas Madden
• Andrew James Magyan, DO
• Kadeesh McNaught
• Lucas Meehan, MD
• Aaron Philip Morrison, PSYD
• Mt Home Refill Phcy
• Bichle Thi Nguyen, D.O.
• Paula Michelle Nordstrom, PH.D.
• McKenzie Leigh Nutter, DDS

• Aerospace Medicine Physician in Mountain Home Afb, ID
• Providers in Mountain Home Afb, ID by specialty
• Aerospace Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.