Provider Demographics
NPI:1922292754
Name:DE MOOR, CARRIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:E
Last Name:DE MOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:WARRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5300 TOWN AND COUNTRY BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6913
Mailing Address - Country:US
Mailing Address - Phone:469-208-5297
Mailing Address - Fax:214-260-0707
Practice Address - Street 1:4701 PAXTON LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2209
Practice Address - Country:US
Practice Address - Phone:469-815-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17374207P00000X
TXM6098207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43603092Medicaid
TX189459401Medicaid
TX189459406Medicaid
TX8W0183OtherBCBS
TX8F22604Medicare PIN
TX189459406Medicaid
TX189459401Medicaid