Healthcare Provider Details

I. General information

NPI: 1104314111
Provider Name (Legal Business Name): CHIP REED MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

IV. Provider business mailing address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

V. Phone/Fax

Practice location:
  • Phone: 325-698-3865
  • Fax:
Mailing address:
  • Phone: 325-698-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberV0815
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberV0815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: