Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | F9837 | TX |
NPI | 1982636742 |
---|---|
Provider Name | Dr. Roderick Donald Moe JR. |
First Address | San Antonio, TX 78229-0749 |
Second Address | San Antonio, TX 78248-2342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 31/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
095065103 | (05) | TX |
126432701 | (05) | TX |
126432706 | (05) | TX |
20082224 | DPS (01) | TX |
B74987 | (02) | TX |
BM326362 | DEA (01) | TX |
F9837 | PHYSICIAN PERMIT (01) | TX |