Provider Demographics
NPI:1437269172
Name:MOORE, REGINALD (MD)
Entity Type:Individual
Prefix:
First Name:REGINALD
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:PO BOX 40159
Mailing Address - Street 2:MC 7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-871-4409
Mailing Address - Fax:201-524-9599
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MC 7977
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-871-4409
Practice Address - Fax:201-524-9599
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH33542080P0207X, 208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160234902OtherCSHCN
TX160284901Medicaid
TX160234902OtherCSHCN
TX8L12206Medicare PIN