Healthcare Provider Details

I. General information

NPI: 1508972142
Provider Name (Legal Business Name): GERHARD MOELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N HIGHWAY 118 DIAGNOSTIC RADIOLOGY DEPARTMENT
ALPINE TX
79830-2002
US

IV. Provider business mailing address

2600 N HIGHWAY 118 DIAGNOSTIC RADIOLOGY DEPARTMENT
ALPINE TX
79830-2002
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-0207
  • Fax: 432-837-0275
Mailing address:
  • Phone: 432-837-0207
  • Fax: 432-837-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberK9132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: