Provider Demographics
NPI:1568572154
Name:TIMOTHY R. MOORE, MD, PA
Entity Type:Organization
Organization Name:TIMOTHY R. MOORE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-641-8648
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-0171
Mailing Address - Country:US
Mailing Address - Phone:325-641-8648
Mailing Address - Fax:325-643-2227
Practice Address - Street 1:2510 CROCKETT DR
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5928
Practice Address - Country:US
Practice Address - Phone:325-641-8648
Practice Address - Fax:325-643-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0189207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071MTOtherBCBS NUMBER
00386ZMedicare ID - Type UnspecifiedMEDICARE GROUP #