MEDICARE: DR. TERRENCE LEE 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
1	207Q00000X	Family Medicine Physician	E6534	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E6534	OTHER	TX	STATE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851399711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRENCE LEE MOORE M.D.

Provider Business Mailing Address
First Line	:	2324 SAN JACINTO BLVD
Second Line	:	SUITE 219
City	:	DENTON
State	:	TX
Zip	:	76205-7534
Country	:	US
Telephone Number	:	940-565-1565
Fax Number	:	940-383-1674

Provider Business Practice Location Address
First Line	:	2324 SAN JACINTO BLVD
Second Line	:	SUITE 219
City	:	DENTON
State	:	TX
Zip	:	76205-7534
Country	:	US
Telephone Number	:	940-565-1565
Fax Number	:	940-383-1674

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/20/2010

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