Provider Demographics
NPI:1689970295
Name:R ANTHONY MOORE MD PA
Entity Type:Organization
Organization Name:R ANTHONY MOORE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-522-1960
Mailing Address - Street 1:3838 OAK LAWN
Mailing Address - Street 2:908
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4520
Mailing Address - Country:US
Mailing Address - Phone:214-522-1960
Mailing Address - Fax:214-522-2510
Practice Address - Street 1:3838 OAK LAWN
Practice Address - Street 2:908
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4520
Practice Address - Country:US
Practice Address - Phone:214-522-1960
Practice Address - Fax:214-522-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1070261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1732166-01Medicaid
TX1732166-01Medicaid