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General NPI Number Information
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NPI Number | 1902769037
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Entity Type | Organization
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Legal Business Name | SDM MEDICAL PLLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 5373 WEST ALABAMA ST SUITE 204
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City | HOUSTON
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State | TX
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Zip | 77056
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Country | US
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Telephone | 832-299-5229
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 TIMBERLOCH PL STE 500
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1375
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Country | US
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Telephone | 832-299-5229
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STACEY DENISE MOORE
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Credential | MD
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Telephone | 832-299-5229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086P0122X
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Taxonomy Name | Physician Nutrition Specialist (Surgery)
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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 | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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