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General NPI Number Information
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NPI Number | 1174940332
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Entity Type | Organization
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Legal Business Name | RML SURGICAL SERVICES
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 109 TRIPLE K CT
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City | WEATHERFORD
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State | TX
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Zip | 76087-8099
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Country | US
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Telephone | 817-800-7171
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Fax | 817-599-8106
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Provider Business Mailing Address
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Address Line | 109 TRIPLE K CT
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City | WEATHERFORD
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State | TX
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Zip | 76087-8099
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Country | US
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Telephone | 817-800-7171
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Fax | 817-599-8106
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Authorized Official
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Title or Position | OWNER
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Name | RAJEAN RACHEL MOSELEY-LARUE
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Credential | PA-C
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Telephone | 817-800-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | TXPA01480
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License Number State | TX
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