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General NPI Number Information
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NPI Number | 1982636742
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Entity Type | Individual
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Provider Name | RODERICK DONALD MOE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 16723 HUEBNER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78248-2342
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Country | US
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Telephone | 210-733-4368
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Fax | 210-402-3417
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Provider Business Mailing Address
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Address Line | 903 W MARTIN ST # MS 49-2
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City | SAN ANTONIO
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State | TX
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Zip | 78207-0903
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Country | US
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Telephone | 210-358-0572
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Fax | 210-358-5940
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | F9837
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | F9837
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License Number State | TX
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