Individual
CRAIG M MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
7451 CHAPEL AVE, FORT WORTH, TX 76116-7090
(817) 294-7444
Mailing address
PO BOX 2626, FORT WORTH, TX 76113-2626
(817) 294-7444
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00971
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95869
CST
TX
Enumeration date
10/31/2012
Last updated
10/23/2024
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