MEDICARE: AMANDA DODSON-MOORING DO

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	207R00000X	Internal Medicine Physician	U3199	TX

General Provider Information

NPI Number	:	1215431481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DODSON-MOORING DO

Provider Business Mailing Address
First Line	:	4200 BRIDGEVIEW DR APT 1033
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5570
Country	:	US
Telephone Number	:	512-538-4656
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 KINGWOOD MEDICAL DR STE 100
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-6408
Country	:	US
Telephone Number	:	281-943-2794
Fax Number	:

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

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	07/24/2023

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