Healthcare Provider Details

I. General information

NPI: 1588600241
Provider Name (Legal Business Name): MOORE FOOT AND ANKLE SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 FM 2920 RD STE N
SPRING TX
77388-3590
US

IV. Provider business mailing address

2616 FM 2920 RD STE N
SPRING TX
77388-3590
US

V. Phone/Fax

Practice location:
  • Phone: 281-444-6300
  • Fax: 832-375-1247
Mailing address:
  • Phone: 281-444-6300
  • Fax: 832-375-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: TATIANA TORRES
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 813-400-1140