MEDICARE: DR. VANESSA K MOORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	L9372	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L9372	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1164574000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA K MOORE MD

Provider Business Mailing Address
First Line	:	5500 GUHN RD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6162
Country	:	US
Telephone Number	:	713-783-8889
Fax Number	:	713-974-2252

Provider Business Practice Location Address
First Line	:	5500 GUHN RD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6162
Country	:	US
Telephone Number	:	713-783-8889
Fax Number	:	713-974-2252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	11/30/2012

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