Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G7089 | TX |
NPI | 1942307269 |
---|---|
Provider Name | Dr. John M Moore |
First Address | Plano, TX 75075-6174 |
Second Address | Plano, TX 75075-6174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 10/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D37435 | (02) | TX |