Healthcare Provider Details

I. General information

NPI: 1346289030
Provider Name (Legal Business Name): HEATHER C MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST 500
HOUSTON TX
77030-3000
US

IV. Provider business mailing address

PO BOX 201088
HOUSTON TX
77216-1088
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7111
  • Fax: 713-512-2227
Mailing address:
  • Phone: 713-500-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL7323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: