Provider Demographics
NPI:1437399185
Name:JOHN M MOORE MD PLLC
Entity Type:Organization
Organization Name:JOHN M MOORE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-861-9135
Mailing Address - Street 1:1600 COIT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6174
Mailing Address - Country:US
Mailing Address - Phone:972-867-9135
Mailing Address - Fax:
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:972-867-9135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7089207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3947Medicare PIN