Provider Demographics
NPI:1699185439
Name:PANJETI-MOORE, DEEPA (DO)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:PANJETI-MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 LYNDON B JOHNSON FWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1288
Mailing Address - Country:US
Mailing Address - Phone:214-750-9977
Mailing Address - Fax:214-265-8653
Practice Address - Street 1:8390 LYNDON B JOHNSON FWY STE 1000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1288
Practice Address - Country:US
Practice Address - Phone:214-750-9977
Practice Address - Fax:214-265-8653
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS75262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty