Provider Demographics
NPI:1295056711
Name:DOREEN MOSER DO PA
Entity type:Organization
Organization Name:DOREEN MOSER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-310-3775
Mailing Address - Street 1:PO BOX 674209
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4209
Mailing Address - Country:US
Mailing Address - Phone:972-616-4000
Mailing Address - Fax:972-294-3343
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:STE 260
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-310-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010TQOtherBCBSTX
TX215673901Medicaid
TXTXB102225Medicare PIN