MEDICARE: DR. DUSTIN GRAHAM MOORE 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	207X00000X	Orthopaedic Surgery Physician	BP1-0040306	TX
2	207X00000X	Orthopaedic Surgery Physician	Q2165	TX

General Provider Information

NPI Number	:	1942593272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN GRAHAM MOORE M.D.

Provider Business Mailing Address
First Line	:	13830 SAWYER RANCH RD STE 302
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-5514
Country	:	US
Telephone Number	:	512-894-2294
Fax Number	:	512-894-2295

Provider Business Practice Location Address
First Line	:	13830 SAWYER RANCH RD STE 302
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-5514
Country	:	US
Telephone Number	:	512-894-2294
Fax Number	:	512-894-2295

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

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	07/21/2022

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