Provider Demographics
NPI:1386649218
Name:MOORE, AL (MD)
Entity Type:Individual
Prefix:
First Name:AL
Middle Name:
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 1:4131 N CENTRAL EXPY
Mailing Address - Street 2:STE 435
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2102
Mailing Address - Country:US
Mailing Address - Phone:214-252-3501
Mailing Address - Fax:
Practice Address - Street 1:4131 N CENTRAL EXPY
Practice Address - Street 2:STE 435
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2102
Practice Address - Country:US
Practice Address - Phone:214-252-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5417207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF67558Medicare UPIN