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General NPI Number Information
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NPI Number | 1033325717
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MOORE P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 3500 SOUTH TERMINAL RD. TERMINAL C TAKECARE MEDICAL CLINIC
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City | HOUSTON
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State | TX
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Zip | 77205
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Country | US
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Telephone | 281-553-1700
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Fax | 281-553-1701
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Provider Business Mailing Address
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Address Line | 1400 EL CAMINO VILLAGE DRIVE #1309
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City | HOUSTON
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State | TX
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Zip | 77058-3059
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Country | US
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Telephone | 281-218-7960
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Fax | 281-553-1700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02213
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License Number State | TX
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