Provider Demographics
NPI:1629393251
Name:MOORE, TIMOTHY O'NEAL
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:O'NEAL
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300232
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0232
Mailing Address - Country:US
Mailing Address - Phone:832-618-3712
Mailing Address - Fax:281-741-7158
Practice Address - Street 1:2850 OAK RD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8853
Practice Address - Country:US
Practice Address - Phone:832-618-3712
Practice Address - Fax:281-741-7158
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08801174172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver