MEDICARE: JOHN MOON III M.D.

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	207Q00000X	Family Medicine Physician	L2479	TX

General Provider Information

NPI Number	:	1417912833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MOON III M.D.

Provider Business Mailing Address
First Line	:	5655 WEST SPRING CREEK PKWY
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75024
Country	:	US
Telephone Number	:	972-599-9600
Fax Number	:	972-599-9696

Provider Business Practice Location Address
First Line	:	5655 WEST SPRING CREEK PKWY
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75024
Country	:	US
Telephone Number	:	972-599-9600
Fax Number	:	972-599-9696

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	02/18/2026

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