Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6315 | TX |
N | 111NR0200X | Radiology | 242 | TX |
N | 213ER0200X | Radiology | 242 | TX |
NPI | 1023201985 |
---|---|
Provider Name | Tiffany Mccoy Moore |
First Address | Flower Mound, TX 75022-4839 |
Second Address | Flower Mound, TX 75022-4839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 23/08/2007 |