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General NPI Number Information
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NPI Number | 1417452897
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Entity Type | Individual
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Provider Name | ALYSSA MARIE MOORE MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 17201 INTERSTATE 45 S
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City | THE WOODLANDS
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State | TX
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Zip | 77385-3311
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Country | US
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Telephone | 936-270-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4535 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718-2545
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Country | US
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Telephone | 330-994-4741
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Fax | 330-409-8835
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | S9235
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License Number State | TX
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