Provider Demographics
NPI:1962562132
Name:MORAN, JEREMY S (DPM)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:S
Last Name:MORAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24914 TOMBALL PKWY STE 180
Mailing Address - Street 2:#140
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5080
Mailing Address - Country:US
Mailing Address - Phone:281-290-0400
Mailing Address - Fax:281-516-0066
Practice Address - Street 1:24914 TOMBALL PKWY
Practice Address - Street 2:#180
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-7690
Practice Address - Country:US
Practice Address - Phone:281-290-0400
Practice Address - Fax:281-516-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1520P213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8300658OtherCIGNA
TX043774102Medicaid
TX0042JWOtherBCBS
TX1520POtherRX #
TX7385429OtherAETNA
TX7385429OtherAETNA
TX8300658OtherCIGNA
TX8F9208Medicare PIN