Healthcare Provider Details

I. General information

NPI: 1417107905
Provider Name (Legal Business Name): JAMES DILLON MOORE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N FM 730 UNIT 105
BOYD TX
76023-3072
US

IV. Provider business mailing address

PO BOX 2078
DECATUR TX
76234-6156
US

V. Phone/Fax

Practice location:
  • Phone: 940-433-2151
  • Fax: 940-433-2366
Mailing address:
  • Phone: 940-626-1370
  • Fax: 940-393-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number710553
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: