Provider Demographics
NPI:1740598150
Name:JOSEPH P. MORAN, D.O., P.A.
Entity Type:Organization
Organization Name:JOSEPH P. MORAN, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-286-9895
Mailing Address - Street 1:1931 S BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253-4702
Mailing Address - Country:US
Mailing Address - Phone:972-286-9895
Mailing Address - Fax:972-557-5350
Practice Address - Street 1:1931 S BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-4702
Practice Address - Country:US
Practice Address - Phone:972-286-9895
Practice Address - Fax:972-557-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67426Medicare UPIN