Provider Demographics
NPI:1235142266
Name:MOORE, ANGELA Y (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:Y
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E LAMAR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3800
Mailing Address - Country:US
Mailing Address - Phone:817-795-7546
Mailing Address - Fax:817-226-7546
Practice Address - Street 1:711 E LAMAR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3800
Practice Address - Country:US
Practice Address - Phone:817-795-7546
Practice Address - Fax:817-226-7546
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4627207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG46183Medicare UPIN
TX00722UMedicare ID - Type UnspecifiedDERMATOLOGY