Provider Demographics
NPI:1639308398
Name:MOSES, DEBRA JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JEAN
Last Name:MOSES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:SMOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:22710 PROFESSIONAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6009
Mailing Address - Country:US
Mailing Address - Phone:281-359-2080
Mailing Address - Fax:281-359-2421
Practice Address - Street 1:451 KINGWOOD MEDICAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-2080
Practice Address - Fax:281-359-2421
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine