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Individual
STACY L MOULDER
Active
Individual
STACY L MOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M1250
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174475701
—
TX
01
—
8P9917
BCBS
TX
01
—
P00347958
RR MEDICARE
TX
Enumeration date
09/25/2006
Last updated
06/18/2012
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