MEDICARE: TIMOTHY R. MOORE, MD, 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
1	207RC0000X	Cardiovascular Disease Physician	M0189	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0071MT	OTHER	TX	BCBS NUMBER

General Provider Information

NPI Number	:	1568572154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY R. MOORE, MD, PA

Provider Business Mailing Address
First Line	:	PO BOX 171
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76804-0171
Country	:	US
Telephone Number	:	325-641-8648
Fax Number	:	325-643-2227

Provider Business Practice Location Address
First Line	:	2510 CROCKETT DR
Second Line	:	SUITE B
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5928
Country	:	US
Telephone Number	:	325-641-8648
Fax Number	:	325-643-2227

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY R MOORE
Credential	:	MD
Telephone Number	:	325-641-8648

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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