Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | H0652 | TX |
NPI | 1003893439 |
---|---|
Provider Name | Dr. Timothy A. Moore |
First Address | Dallas, TX 75265-0426 |
Second Address | Dallas, TX 75231-4426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 21/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130384404 | (05) | TX |
130384405 | (05) | TX |
E07165 | (02) |