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General NPI Number Information
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NPI Number | 1245442128
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Entity Type | Organization
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Legal Business Name | SANDRA V. MOORE MDPA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 WALTER REED BLVD SUITE 301
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City | GARLAND
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State | TX
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Zip | 75042-3701
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Country | US
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Telephone | 972-276-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 700 WALTER REED BLVD SUITE 301
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City | GARLAND
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State | TX
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Zip | 75042-3701
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Country | US
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Telephone | 972-276-5500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA VELIA MOORE
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Credential |
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Telephone | 972-276-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | F1836
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License Number State | TX
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