Provider Demographics
NPI:1568617017
Name:MOORE, DEBORAH LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:LEA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1619 S KENTUCKY ST
Mailing Address - Street 2:SUITE F600
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2239
Mailing Address - Country:US
Mailing Address - Phone:806-373-2200
Mailing Address - Fax:
Practice Address - Street 1:1619 S KENTUCKY ST
Practice Address - Street 2:SUITE F600
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2239
Practice Address - Country:US
Practice Address - Phone:806-373-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47245207Q00000X
TXP8391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine