Provider Demographics
NPI:1144289034
Name:MOELLER, ERICA C (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:C
Last Name:MOELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:C
Other - Last Name:MOELLER-RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:512-334-2589
Practice Address - Street 1:5701 W SLAUGHTER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6527
Practice Address - Country:US
Practice Address - Phone:512-901-4031
Practice Address - Fax:512-334-2589
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117018506Medicaid
TX080138810OtherRRMDCR
TX117018504Medicaid
TX84Z926Medicare PIN
TX117018506Medicaid
TXG52252Medicare UPIN
TX313946YNBVMedicare PIN