Provider Demographics
NPI:1215431481
Name:DODSON-MOORING, AMANDA (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DODSON-MOORING
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 1:4200 BRIDGEVIEW DR APT 1033
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5570
Mailing Address - Country:US
Mailing Address - Phone:512-538-4656
Mailing Address - Fax:
Practice Address - Street 1:451 KINGWOOD MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6408
Practice Address - Country:US
Practice Address - Phone:281-943-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU3199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine