Provider Demographics
NPI:1942307269
Name:MOORE, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1600 COIT RD.
Mailing Address - Street 2:#103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6174
Mailing Address - Country:US
Mailing Address - Phone:972-867-9135
Mailing Address - Fax:972-612-5048
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:#103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:972-867-9135
Practice Address - Fax:972-612-5048
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7089207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A90NMedicare ID - Type Unspecified
TXD37435Medicare UPIN
TX8F21528Medicare PIN