Provider Demographics
NPI:1467434704
Name:MOSES, RON LEE (MD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:LEE
Last Name:MOSES
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 1:4191 BELLAIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1003
Mailing Address - Country:US
Mailing Address - Phone:713-795-5343
Mailing Address - Fax:713-795-4851
Practice Address - Street 1:4191 BELLAIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1003
Practice Address - Country:US
Practice Address - Phone:713-795-5343
Practice Address - Fax:713-795-4851
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6168207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044886201Medicaid
TX83632XOtherBLUE CROSS
TX044886201Medicaid
TX83632XOtherBLUE CROSS