Provider Demographics
NPI:1811159932
Name:MOORE, DONALD MICHAEL
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MICHAEL
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 1:10002 WAVING FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4430
Mailing Address - Country:US
Mailing Address - Phone:281-469-9997
Mailing Address - Fax:281-469-9982
Practice Address - Street 1:10002 WAVING FIELDS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4430
Practice Address - Country:US
Practice Address - Phone:281-469-9997
Practice Address - Fax:281-469-9982
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide