Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 23265 | TX |
NPI | 1255355707 |
---|---|
Provider Name | Dr. Michelle P Moran |
First Address | San Antonio, TX 78212-3955 |
Second Address | San Antonio, TX 78212-3955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
032702501 | (05) | TX |
17429865896000 | (02) | TX |