Provider Demographics
NPI:1649272626
Name:TERRENCE L. MOORE, M.D. P.A
Entity type:Organization
Organization Name:TERRENCE L. MOORE, M.D. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-565-1565
Mailing Address - Street 1:2324 SAN JACINTO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7534
Mailing Address - Country:US
Mailing Address - Phone:940-565-1565
Mailing Address - Fax:940-383-1674
Practice Address - Street 1:2324 SAN JACINTO BLVD
Practice Address - Street 2:#219
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7534
Practice Address - Country:US
Practice Address - Phone:940-565-1565
Practice Address - Fax:940-383-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079957901Medicaid
TX0012BVMedicare ID - Type Unspecified