Provider Demographics
NPI:1699095752
Name:SHARIE A. MOORE, M.D., P.A.
Entity type:Organization
Organization Name:SHARIE A. MOORE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-652-3373
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:LOCKNEY
Mailing Address - State:TX
Mailing Address - Zip Code:79241-0037
Mailing Address - Country:US
Mailing Address - Phone:806-652-3373
Mailing Address - Fax:806-652-2417
Practice Address - Street 1:320 N MAIN
Practice Address - Street 2:
Practice Address - City:LOCKNEY
Practice Address - State:TX
Practice Address - Zip Code:79241-0037
Practice Address - Country:US
Practice Address - Phone:806-652-3373
Practice Address - Fax:806-652-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130928801Medicaid
TX00534LMedicare PIN