Provider Demographics
NPI:1245466457
Name:MOORE, GRAYSON ARMSTRONG (MD)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:ARMSTRONG
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 1:13830 SAWYER RANCH RD STE 302
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5514
Mailing Address - Country:US
Mailing Address - Phone:512-894-2294
Mailing Address - Fax:
Practice Address - Street 1:13830 SAWYER RANCH RD STE 302
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620
Practice Address - Country:US
Practice Address - Phone:512-894-2294
Practice Address - Fax:512-895-2295
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ1861207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355141803Medicaid
421353YL9XOtherMEDICARE