Provider Demographics
NPI:1033325717
Name:MOORE, MICHAEL JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MOORE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1400 EL CAMINO VILLAGE DRIVE
Mailing Address - Street 2:#1309
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3059
Mailing Address - Country:US
Mailing Address - Phone:281-218-7960
Mailing Address - Fax:281-553-1700
Practice Address - Street 1:3500 SOUTH TERMINAL RD.
Practice Address - Street 2:TERMINAL C TAKECARE MEDICAL CLINIC
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77205
Practice Address - Country:US
Practice Address - Phone:281-553-1700
Practice Address - Fax:281-553-1701
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-04-01
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Provider Licenses
StateLicense IDTaxonomies
TXPA02213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant