Provider Demographics
NPI:1891736138
Name:MOORE, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4730 N HABANA AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7148
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-864-4436
Practice Address - Street 1:6900 HARRIS PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4255
Practice Address - Country:US
Practice Address - Phone:817-292-8585
Practice Address - Fax:855-810-8998
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM1948207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182329608Medicaid
TX182329606Medicaid
TX182329607Medicaid
TX8L21348Medicare PIN
TX182329608Medicaid
TX182329606Medicaid
TX8L21349Medicare PIN