Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Glen Matthew Moore, MD

Individual provider Family Medicine Physician · NPI 1568600963

Glen Matthew Moore, MD is a Family Practice in Fontana, California. Graduated from University of California, Irvine, California College of Medicine in 2006, 20 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
20
Trained at
University of California, Irvine, California College of Medicine
Licensed in
CA
In the registry since
2009
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

9961 Sierra Ave
Fontana, CA 92335-6720
Phone: (909) 427-5083
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A103719 (CA)

Record details

NPI number1568600963
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJanuary 23, 2009
Last updated in NPPESSeptember 8, 2022
Certification dateSeptember 8, 2022
Mailing address9961 Sierra Ave, Fontana, CA 92335-6720

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Also practisesSPORTS MEDICINE
Medical schoolUNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Graduated 2006 (20 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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