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NPI Code Detail

MEDICARE: DR. MICHAEL WILLIAM SHAW MOORE III M.D.

MEDICARE: DR. MICHAEL WILLIAM SHAW MOORE III 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
1207Y00000XOtolaryngology PhysicianLL33725SC
2207Y00000XOtolaryngology PhysicianQ6968TX

General Provider Information

NPI Number : 1508151481
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL WILLIAM SHAW MOORE III M.D.
Provider Business Mailing Address
First Line : 2500 TANGLEWILDE ST
Second Line : STE 160
City : HOUSTON
State : TX
Zip : 77063-2100
Country : US
Telephone Number : 713-780-9660
Fax Number : 713-974-3672
Provider Business Practice Location Address
First Line : 10740 N GESSNER RD
Second Line : STE 310
City : HOUSTON
State : TX
Zip : 77064-1240
Country : US
Telephone Number : 281-897-0416
Fax Number : 281-890-8908
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2011
Last Update Date : 08/09/2021

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