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General NPI Number Information
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NPI Number | 1730478744
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Entity Type | Organization
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Legal Business Name | PHILIP A. MOORE, M.D., P.A.
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 1600 W COLLEGE ST SUITE LL20
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City | GRAPEVINE
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State | TX
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Zip | 76051-3580
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Country | US
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Telephone | 817-488-5170
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Fax | 817-488-6270
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Provider Business Mailing Address
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Address Line | 1600 W COLLEGE ST SUITE LL20
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City | GRAPEVINE
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State | TX
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Zip | 76051-3580
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Country | US
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Telephone | 817-488-5170
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Fax | 817-488-6270
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP ALAN MOORE
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Credential | M.D.
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Telephone | 817-488-5170
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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 | F1835
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License Number State | TX
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