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NPI Code Detail

MEDICARE: MS. DONNA LOUISE MOORE PA

MEDICARE: MS. DONNA LOUISE MOORE PA
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
1363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11084415OTHERTXNCCPA

General Provider Information

NPI Number : 1235375577
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DONNA LOUISE MOORE PA
Provider Business Mailing Address
First Line : PO BOX 2828
Second Line : 1602 10TH STREET
City : LUBBOCK
State : TX
Zip : 79408-2828
Country : US
Telephone Number : 806-766-0310
Fax Number : 806-766-0397
Provider Business Practice Location Address
First Line : 1950 ASPEN AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79404-1211
Country : US
Telephone Number : 806-766-0310
Fax Number : 806-766-0397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2008
Last Update Date : 12/16/2008

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Directions to “ MS. DONNA LOUISE MOORE PA” Practice Location

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