Provider Demographics
NPI:1437150687
Name:MOORE, SHARMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARMAN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARMAN
Other - Middle Name:A
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:320 N. MAIN
Mailing Address - City:LOCKNEY
Mailing Address - State:TX
Mailing Address - Zip Code:79241-0037
Mailing Address - Country:US
Mailing Address - Phone:806-652-3373
Mailing Address - Fax:806-652-2417
Practice Address - Street 1:320 N MAIN
Practice Address - Street 2:
Practice Address - City:LOCKNEY
Practice Address - State:TX
Practice Address - Zip Code:79241-0037
Practice Address - Country:US
Practice Address - Phone:806-652-3373
Practice Address - Fax:806-652-2417
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-06-29
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXK5356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130928806Medicaid
TX130928801Medicaid
TXTXB101277Medicare PIN
TXG96945Medicare UPIN
TX130928801Medicaid
TXTXB101278Medicare PIN