Provider Demographics
NPI:1407940547
Name:MOORE, J. KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:J. KATHLEEN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JERRI
Other - Middle Name:KATHLEEN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:809 SINGLETON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-4014
Mailing Address - Country:US
Mailing Address - Phone:214-540-0300
Mailing Address - Fax:214-540-0308
Practice Address - Street 1:809 SINGLETON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4014
Practice Address - Country:US
Practice Address - Phone:214-540-0300
Practice Address - Fax:214-540-0308
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26000208000000X
TXJ0605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0605OtherMEDICAL LIS
TXJ0605OtherMEDICAL LIS