Provider Demographics
NPI:1073517736
Name:MOORE, FROSTY DOYLE RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:FROSTY
Middle Name:DOYLE RANDALL
Last Name:MOORE
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 1:13830 SAWYER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5513
Mailing Address - Country:US
Mailing Address - Phone:512-894-2294
Mailing Address - Fax:
Practice Address - Street 1:13830 SAWYER RANCH RD
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5513
Practice Address - Country:US
Practice Address - Phone:512-894-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1959207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128726-02Medicaid
TX8M5473OtherBC/BS
TX1286726-06Medicaid
TX8K4101Medicare PIN
TX1286726-06Medicaid