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1972667665 NPI number — D SCOTT MOORE DO

NPI Number: 1972667665
Health Care Provider/Practitioner: D SCOTT MOORE DO

Information about “1972667665” NPI (D SCOTT MOORE DO) exists in 1972667665 in HTML format HTML  |  1972667665 in plain Text format TXT  |  1972667665 in PDF (Portable Document Format) PDF  |  1972667665 in an XML format XML  formats.

NPI Number : 1972667665 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972667665",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOORE",
    "FirstName": "D SCOTT",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "ST VINCENTS EMERGENCY PHYSICIANS INC 4685 RELIABLE PKWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60686-0046",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-802-3140",
    "MailingAddressFaxNumber": "317-870-6719",
    "FirstLinePracticeLocationAddress": "2001 W 86TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46260-1902",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-802-3140",
    "PracticeLocationAddressFaxNumber": "317-870-0499",
    "EnumerationDate": "12/20/2006",
    "LastUpdateDate": "04/23/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "1039",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "02002731A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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