Individual
FRED MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
800 W HIGHWAY 71, MARBLE FALLS, TX 78654-8606
(830) 201-7100
(830) 201-7304
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02272
TX
363AM0700X
Medical Physician Assistant
PA02272
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA02272
STATE LICENSE
TX
Enumeration date
10/13/2006
Last updated
06/13/2019
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