Provider Demographics
NPI:1760639934
Name:BUFFORD D MOORE MD PA
Entity Type:Organization
Organization Name:BUFFORD D MOORE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BUFFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-422-5000
Mailing Address - Street 1:2802 GARTH RD
Mailing Address - Street 2:STE 301
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3900
Mailing Address - Country:US
Mailing Address - Phone:281-422-5000
Mailing Address - Fax:281-422-5005
Practice Address - Street 1:2802 GARTH RD
Practice Address - Street 2:STE 301
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3900
Practice Address - Country:US
Practice Address - Phone:281-422-5000
Practice Address - Fax:281-422-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205624402Medicaid
TXTXB149130OtherMEDICARE PTAN