Provider Demographics
NPI:1508972142
Name:MOELLER, GERHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERHARD
Middle Name:
Last Name:MOELLER
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 1:2600 N HIGHWAY 118
Mailing Address - Street 2:DIAGNOSTIC RADIOLOGY DEPARTMENT
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-2002
Mailing Address - Country:US
Mailing Address - Phone:432-837-0207
Mailing Address - Fax:432-837-0275
Practice Address - Street 1:2600 N HIGHWAY 118
Practice Address - Street 2:DIAGNOSTIC RADIOLOGY DEPARTMENT
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-2002
Practice Address - Country:US
Practice Address - Phone:432-837-0207
Practice Address - Fax:432-837-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK91322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145999202Medicaid
TX8B0690OtherBCBS PROVIDER #
TX342167YKR0Medicare PIN