Provider Demographics
NPI:1245239557
Name:MORAN, JOSEPH PATRICK SR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:MORAN
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 S BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253-4702
Mailing Address - Country:US
Mailing Address - Phone:972-286-9895
Mailing Address - Fax:972-557-5350
Practice Address - Street 1:1931 S BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-4702
Practice Address - Country:US
Practice Address - Phone:972-286-9895
Practice Address - Fax:972-557-5350
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TXH5408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031606901Medicaid
TX031606901Medicaid
TXA67426Medicare UPIN