Provider Demographics
NPI:1164574000
Name:MOORE, VANESSA K (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:K
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5500 GUHN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6162
Mailing Address - Country:US
Mailing Address - Phone:713-783-8889
Mailing Address - Fax:713-974-2252
Practice Address - Street 1:5500 GUHN RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6162
Practice Address - Country:US
Practice Address - Phone:713-783-8889
Practice Address - Fax:713-974-2252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL93722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL9372OtherLICENSE