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NPI Code Detail

MEDICARE: FROSTY DOYLE RANDALL MOORE M.D.

MEDICARE:   FROSTY DOYLE RANDALL MOORE  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery PhysicianG1959TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28M5473OTHERTXBC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073517736
Entity Type Code : Individual
Provider Name (Legal Business Name) : FROSTY DOYLE RANDALL MOORE M.D.
Provider Business Mailing Address
First Line : 13830 SAWYER RANCH RD
Second Line :
City : DRIPPING SPRINGS
State : TX
Zip : 78620-5513
Country : US
Telephone Number : 512-894-2294
Fax Number :
Provider Business Practice Location Address
First Line : 13830 SAWYER RANCH RD
Second Line :
City : DRIPPING SPRINGS
State : TX
Zip : 78620-5513
Country : US
Telephone Number : 512-894-2294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 10/19/2017

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Directions to “ FROSTY DOYLE RANDALL MOORE M.D.” Practice Location

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