Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N8427 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | N8427 | TX |
NPI | 1023280039 |
---|---|
Provider Name | Dr. Vicki P Moore |
First Address | Dallas, TX 75284-7057 |
Second Address | Dallas, TX 75390-7057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 02/12/2020 |