Provider Demographics
NPI:1245241124
Name:MOORE, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
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 1:7010 CHAMPIONS PLAZA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2395
Mailing Address - Country:US
Mailing Address - Phone:936-755-4412
Mailing Address - Fax:713-442-2169
Practice Address - Street 1:9100 FOREST XING STE A
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1194
Practice Address - Country:US
Practice Address - Phone:936-755-4412
Practice Address - Fax:713-422-2169
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6533208VP0014X, 207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128787208Medicaid
TXP01097809OtherRAILROAD MEDICARE
TX128787203Medicaid
TX128787209Medicaid
D67431Medicare UPIN
TX128787209Medicaid