# DR. PETER MOORE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1770706053
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC0700X | Clinical Psychologist | 3-0929 | TX | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 3-0929 | TX | Yes |

## Other

- **Enumeration date:** 04/11/2007
- **Last updated:** 04/24/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 144475401 | — | TX |
| 01 | — | 51ES | BLUE CROSS BLUE SHIELD | TX |