Healthcare Provider Details

I. General information

NPI: 1588831127
Provider Name (Legal Business Name): SARAH W MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ESPERANZA XING APT 5313
AUSTIN TX
78758-2646
US

IV. Provider business mailing address

2600 ESPERANZA XING APT 5313
AUSTIN TX
78758-2646
US

V. Phone/Fax

Practice location:
  • Phone: 801-652-3980
  • Fax: 504-298-8415
Mailing address:
  • Phone: 801-652-3980
  • Fax: 504-298-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ9684
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ9684
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number260513
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: