Provider Demographics
NPI:1912000118
Name:MOORE, JAMES OTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OTIS
Last Name:MOORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3318
Mailing Address - Country:US
Mailing Address - Phone:210-576-5306
Mailing Address - Fax:210-694-0645
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:STE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-576-0645
Practice Address - Fax:210-694-0645
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-09-30
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Provider Licenses
StateLicense IDTaxonomies
TXH6449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB150017OtherWELLMED MEDICAL GROUP PA
TX262940YL7NOtherWELLMED NETWORKS INC