Healthcare Provider Details

I. General information

NPI: 1194721944
Provider Name (Legal Business Name): DOREEN A MOSER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 LANCASTER DR STE 204
GRAPEVINE TX
76051-3501
US

IV. Provider business mailing address

PO BOX 200282
DALLAS TX
75320-0282
US

V. Phone/Fax

Practice location:
  • Phone: 817-310-3775
  • Fax:
Mailing address:
  • Phone: 972-616-4000
  • Fax: 972-294-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ5186
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberJ5186
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberJ5186
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberJ5186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: