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Organization
MOUNT MORIAH FAMILY MEDICINE, PLLC
Active
Organization
MOUNT MORIAH FAMILY MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIAS FLORES LARA JR. D.O. (MEDICAL DIRECTOR)
(817) 368-4136
Entity
Organization
Contact information
Practice address
151 WALTON WAY STE 107, MIDLOTHIAN, TX 76065-8010
(469) 672-2100
(469) 672-2101
Mailing address
1312 TANGLEWOOD DR, MANSFIELD, TX 76063-7696
(817) 473-6063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N3814
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1H3426
MEDICARE
TX
05
—
355643304
—
TX
Enumeration date
09/15/2010
Last updated
10/27/2020
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