Provider Demographics
NPI:1265507941
Name:ANGELA YEN MOORE, MD PA
Entity Type:Organization
Organization Name:ANGELA YEN MOORE, MD PA
Other - Org Name:ARLINGTON CENTER FOR DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:YEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-795-7546
Mailing Address - Street 1:711 E LAMAR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3888
Mailing Address - Country:US
Mailing Address - Phone:817-795-7546
Mailing Address - Fax:817-226-7546
Practice Address - Street 1:711 E LAMAR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3888
Practice Address - Country:US
Practice Address - Phone:817-795-7546
Practice Address - Fax:817-226-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4627207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG46183Medicare UPIN
TX00722UMedicare ID - Type Unspecified