MEDICARE: DR. ANGELA Y. MOORE MD, PA

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
1	207N00000X	Dermatology Physician	J4627	TX
2	207ND0900X	Dermatopathology Physician	J4627	TX

General Provider Information

NPI Number	:	1235142266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA Y. MOORE MD, PA

Provider Business Mailing Address
First Line	:	711 E LAMAR BLVD STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3800
Country	:	US
Telephone Number	:	817-795-7546
Fax Number	:	817-226-7546

Provider Business Practice Location Address
First Line	:	711 E LAMAR BLVD STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3800
Country	:	US
Telephone Number	:	817-795-7546
Fax Number	:	817-226-7546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/11/2025

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