Organization
KERRY F. MOORE M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERRY F MOORE M.D. (CEO)
(760) 242-4101
Entity
Organization
Contact information
Practice address
16049 TUSCOLA RD, SUITE B, APPLE VALLEY, CA 92307-1319
(760) 242-4101
(760) 242-8256
Mailing address
16049 TUSCOLA RD, SUITE B, APPLE VALLEY, CA 92307-1319
(760) 242-4101
(760) 242-8256
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
A41582
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A415820
—
CA
Enumeration date
11/17/2006
Last updated
08/22/2020
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