Provider Demographics
NPI:1598838435
Name:MOORE, PAMELA DIONE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DIONE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:DIONE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6300 STONEWOOD DR
Mailing Address - Street 2:#200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-867-1803
Mailing Address - Fax:972-867-1603
Practice Address - Street 1:6300 STONEWOOD DR
Practice Address - Street 2:#200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-867-1803
Practice Address - Fax:972-867-1603
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00173DMedicare ID - Type Unspecified
G34228Medicare UPIN