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General NPI Number Information
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NPI Number | 1255515235
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Entity Type | Organization
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Legal Business Name | A. G. MOORE M.D, P.A.
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 1120 MEDICAL PLAZA DR SUITE 340
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City | SHENANDOAH
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State | TX
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Zip | 77380-3242
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Country | US
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Telephone | 281-296-8686
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Fax | 281-292-8804
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Provider Business Mailing Address
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Address Line | 1120 MEDICAL PLAZA DR SUITE 340
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City | SHENANDOAH
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State | TX
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Zip | 77380-3242
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Country | US
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Telephone | 281-296-8686
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Fax | 281-292-8804
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MISS SUZANNE MANESS
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Credential |
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Telephone | 281-296-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E8741
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License Number State | TX
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