Provider Demographics
NPI:1427161694
Name:MOORE, HOWARD A (MD, ASSOCIATED)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD, ASSOCIATED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N CARROLL AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6607
Mailing Address - Country:US
Mailing Address - Phone:214-824-7744
Mailing Address - Fax:214-824-7755
Practice Address - Street 1:1015 N CARROLL AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6607
Practice Address - Country:US
Practice Address - Phone:214-824-7744
Practice Address - Fax:214-824-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3736207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033020101Medicaid
TXC19526Medicare UPIN
TX00EP84Medicare ID - Type Unspecified