Provider Demographics
NPI:1558696518
Name:GERALD C. MOORE, MD, PA
Entity Type:Organization
Organization Name:GERALD C. MOORE, MD, PA
Other - Org Name:NORTH TEXAS ASTHMA & ALLERGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-1600
Mailing Address - Street 1:3721 W 15TH ST STE 602
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7755
Mailing Address - Country:US
Mailing Address - Phone:972-867-1600
Mailing Address - Fax:972-596-2819
Practice Address - Street 1:3721 W 15TH ST STE 602
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7755
Practice Address - Country:US
Practice Address - Phone:972-867-1600
Practice Address - Fax:972-596-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657998163W00000X
TXD9577207KA0200X
TXL5849207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AR65Medicare PIN