Healthcare Provider Details

I. General information

NPI: 1285196006
Provider Name (Legal Business Name): DAVID GABRIEL MORA-BOELLSTORFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3387 UNIVERSITY DR E STE 412
BRYAN TX
77802-3470
US

IV. Provider business mailing address

PO BOX 737507
DALLAS TX
75373-7507
US

V. Phone/Fax

Practice location:
  • Phone: 713-524-3434
  • Fax: 713-524-3220
Mailing address:
  • Phone: 713-524-3434
  • Fax: 713-524-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberW7091
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberW7091
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: