Provider Demographics
NPI:1447405980
Name:MOORE, BYRON HAYNES (MD)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:HAYNES
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 4677
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4677
Mailing Address - Country:US
Mailing Address - Phone:713-441-3490
Mailing Address - Fax:713-793-1603
Practice Address - Street 1:1 BAYLOR PLZ RM 286A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-5071
Practice Address - Fax:713-793-1603
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10025392390200000X
TXN8694207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program