Provider Demographics
NPI:1861749624
Name:MOORE, DEMEQUA LEGAIL (MD)
Entity type:Individual
Prefix:DR
First Name:DEMEQUA
Middle Name:LEGAIL
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEMEQUA
Other - Middle Name:LEGAIL
Other - Last Name:DEROUSSELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11803 SOUTH FWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7012
Mailing Address - Country:US
Mailing Address - Phone:817-293-1403
Mailing Address - Fax:
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 213
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7314207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology