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General NPI Number Information
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NPI Number | 1609006311
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Entity Type | Organization
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Legal Business Name | JOHN C MOORE MD PC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 3800 S FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-1206
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Country | US
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Telephone | 213-309-2092
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Fax |
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Provider Business Mailing Address
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Address Line | 419 N LARCHMONT BLVD #55
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone | 213-309-2092
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN D MOORE
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Credential | M.D.
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Telephone | 213-309-2092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G39235
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License Number State | CA
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