{
"Npi": {
"NPI": "1558435263",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KERRY F. MOORE M.D.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "16049 TUSCOLA RD",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "APPLE VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92307-1319",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-242-4101",
"MailingAddressFaxNumber": "760-242-8256",
"FirstLinePracticeLocationAddress": "16049 TUSCOLA RD",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "APPLE VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92307-1319",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-242-4101",
"PracticeLocationAddressFaxNumber": "760-242-8256",
"EnumerationDate": "11/17/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOORE",
"AuthorizedOfficialFirstName": "KERRY",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "760-242-4101",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "A41582",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}