Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | N5259 | TX |
N | 207QA0505X | Family Doctor - Adult Medicine | N5259 | TX |
NPI | 1235458076 |
---|---|
Provider Name | Dr. Alton Earl Moore II |
First Address | Humble, TX 77338-4217 |
Second Address | Humble, TX 77338-4217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 27/03/2020 |