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General NPI Number Information
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NPI Number | 1558696518
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Entity Type | Organization
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Legal Business Name | GERALD C. MOORE, MD, PA
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 3721 W 15TH ST STE 602
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City | PLANO
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State | TX
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Zip | 75075-7755
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Country | US
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Telephone | 972-867-1600
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Fax | 972-596-2819
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Provider Business Mailing Address
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Address Line | 3721 W 15TH ST STE 602
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City | PLANO
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State | TX
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Zip | 75075-7755
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Country | US
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Telephone | 972-867-1600
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Fax | 972-596-2819
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Authorized Official
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Title or Position | CEO
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Name | DR. GERALD CLINTON MOORE
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Credential | M.D.
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Telephone | 972-867-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 657998
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | L5849
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | D9577
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License Number State | TX
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