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General NPI Number Information
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NPI Number | 1679560817
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Entity Type | Individual
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Provider Name | EFREN ANTONIO MORENO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 6999 MCPHERSON RD SUITE 110
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City | LAREDO
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State | TX
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Zip | 78041-6449
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Country | US
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Telephone | 956-722-8263
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Fax | 956-727-5321
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Provider Business Mailing Address
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Address Line | 6999 MCPHERSON RD SUITE 110
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City | LAREDO
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State | TX
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Zip | 78041-6449
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Country | US
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Telephone | 956-722-8263
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Fax | 956-727-5321
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | H5938
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License Number State | TX
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