MEDICARE: R ANTHONY 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	261QM2500X	Medical Specialty Clinic/Center	E1070	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689970295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R ANTHONY MOORE MD PA

Provider Business Mailing Address
First Line	:	3838 OAK LAWN
Second Line	:	908
City	:	DALLAS
State	:	TX
Zip	:	75219-4520
Country	:	US
Telephone Number	:	214-522-1960
Fax Number	:	214-522-2510

Provider Business Practice Location Address
First Line	:	3838 OAK LAWN
Second Line	:	908
City	:	DALLAS
State	:	TX
Zip	:	75219-4520
Country	:	US
Telephone Number	:	214-522-1960
Fax Number	:	214-522-2510

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT ANTHONY MOORE
Credential	:	MD
Telephone Number	:	214-522-1960

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/28/2011

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