Provider Demographics
NPI:1588627921
Name:MOORE, CARTER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:J
Last Name:MOORE
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 1:304 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2328
Mailing Address - Country:US
Mailing Address - Phone:903-572-5882
Mailing Address - Fax:903-572-7330
Practice Address - Street 1:304 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2328
Practice Address - Country:US
Practice Address - Phone:903-572-5882
Practice Address - Fax:903-572-7330
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6448207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1155665-03Medicaid
TX1155665-03Medicaid
TXM000N45GMedicare ID - Type UnspecifiedPREVIOUS MEDICARE ID