Provider Demographics
NPI:1043797723
Name:MOON, RICHARD SLOAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SLOAN
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POBOX 505
Mailing Address - Street 2:202 W CASKEY
Mailing Address - City:FLORENCE
Mailing Address - State:TX
Mailing Address - Zip Code:76527
Mailing Address - Country:US
Mailing Address - Phone:254-793-2240
Mailing Address - Fax:
Practice Address - Street 1:202 W CASKEY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:TX
Practice Address - Zip Code:76527
Practice Address - Country:US
Practice Address - Phone:254-793-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-6531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine