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NPI Code Detail

MEDICARE: STACEY DENISE MOORE M.D.

MEDICARE: STACEY DENISE 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
1202D00000XIntegrative Medicine Physician112023GA
22086P0122XPhysician Nutrition Specialist (Surgery)206758CA
3202D00000XIntegrative Medicine PhysicianD0105958MD
42083B0002XObesity Medicine (Preventive Medicine) PhysicianM8193TX
52086P0122XPhysician Nutrition Specialist (Surgery)D0105958MD
62086P0122XPhysician Nutrition Specialist (Surgery)0101289204VA
7202D00000XIntegrative Medicine Physician61731KY
82086P0122XPhysician Nutrition Specialist (Surgery)35.154137OH
9202D00000XIntegrative Medicine Physician206758CA
10202D00000XIntegrative Medicine Physician0101289204VA
112086P0122XPhysician Nutrition Specialist (Surgery)M8193TX
122086P0122XPhysician Nutrition Specialist (Surgery)61731KY
13202D00000XIntegrative Medicine PhysicianM8193TX
14202D00000XIntegrative Medicine Physician35.154137OH
152086P0122XPhysician Nutrition Specialist (Surgery)112023GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28CA598OTHERTXBCBS

General Provider Information

NPI Number : 1982887493
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY DENISE MOORE M.D.
Provider Business Mailing Address
First Line : 20211 CYPRESSWOOD ESTATES RUN
Second Line :
City : SPRING
State : TX
Zip : 77373-3295
Country : US
Telephone Number : 832-496-4855
Fax Number :
Provider Business Practice Location 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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2007
Last Update Date : 05/18/2026

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Directions to “ STACEY DENISE MOORE M.D.” Practice Location

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