Provider Demographics
NPI:1992136196
Name:MOORE, TIMOTHY (RD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3513
Mailing Address - Country:US
Mailing Address - Phone:512-576-9797
Mailing Address - Fax:
Practice Address - Street 1:1900 CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3513
Practice Address - Country:US
Practice Address - Phone:512-576-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education