Provider Demographics
NPI:1194721944
Name:MOSER, DOREEN A (DO)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:A
Last Name:MOSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674209
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4209
Mailing Address - Country:US
Mailing Address - Phone:972-616-4000
Mailing Address - Fax:972-294-3343
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:STE 260
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-310-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5186207VG0400X, 207VM0101X, 207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096896801Medicaid
TX0083CXOtherBCBS
TX096896804Medicaid
TX8CK620OtherBCBS
TX0083CXOtherBCBS
TXTXB102226Medicare PIN
TX8CK620OtherBCBS
TX096896801Medicaid