Healthcare Provider Details

I. General information

NPI: 1588653794
Provider Name (Legal Business Name): REMIS MARK MOORE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MATLOCK CENTRE CIR
ARLINGTON TX
76015-2535
US

IV. Provider business mailing address

DEPT. #394 P.O. BOX 1000
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 817-693-1000
  • Fax: 866-950-0295
Mailing address:
  • Phone: 941-300-4440
  • Fax: 941-404-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: