Provider Demographics
NPI:1700846730
Name:MOORE, DEBORA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1700 N OREGON ST
Mailing Address - Street 2:STE 560
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3584
Mailing Address - Country:US
Mailing Address - Phone:915-838-1193
Mailing Address - Fax:915-838-1198
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:STE 560
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-838-1193
Practice Address - Fax:915-838-1198
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6531208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L6531OtherLICENSE
8C2726Medicare ID - Type Unspecified
L6531OtherLICENSE