MEDICARE: CARTER J MOORE MD PLLC

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	207VX0000X	Obstetrics Physician	H6448	TX
2	207VG0400X	Gynecology Physician	H6448	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00N45G	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1881957819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTER J MOORE MD PLLC

Provider Business Mailing Address
First Line	:	304 W 20TH ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2328
Country	:	US
Telephone Number	:	903-572-5882
Fax Number	:	903-572-7330

Provider Business Practice Location Address
First Line	:	304 W 20TH ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2328
Country	:	US
Telephone Number	:	903-572-5882
Fax Number	:	903-572-7330

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. CARTER J MOORE
Credential	:	M.D.
Telephone Number	:	903-572-5882

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	01/02/2019

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Directions to “CARTER J MOORE MD PLLC ” Practice Location

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