Provider Demographics
NPI:1912092156
Name:MOORE, PAUL TERRENCE (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TERRENCE
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8722 GREENVILLE AVE
Mailing Address - Street 2:BLDG. E SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7167
Mailing Address - Country:US
Mailing Address - Phone:972-272-6558
Mailing Address - Fax:972-200-5111
Practice Address - Street 1:8722 GREENVILLE AVE
Practice Address - Street 2:BLDG. E SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7167
Practice Address - Country:US
Practice Address - Phone:972-272-6558
Practice Address - Fax:972-200-5111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK 0137174400000X
TXK01372084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE38302Medicare UPIN
TX00445 LMedicare ID - Type Unspecified