MEDICARE: SDM MEDICAL 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	2086P0122X	Physician Nutrition Specialist (Surgery)
2	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1902769037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SDM MEDICAL PLLC

Provider Business Mailing Address
First Line	:	5373 W ALABAMA ST STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-5923
Country	:	US
Telephone Number	:	832-299-5229
Fax Number	:

Provider Business Practice Location Address
First Line	:	5373 WEST ALABAMA ST SUITE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056
Country	:	US
Telephone Number	:	832-299-5229
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. STACEY DENISE MOORE
Credential	:	MD
Telephone Number	:	832-299-5229

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	05/18/2026

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Directions to “SDM MEDICAL PLLC ” Practice Location

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