Individual
DR. THOMAS WYLIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16651 SOUTHWEST FWY, SUITE 360, SUGAR LAND, TX 77479-2345
(713) 772-1200
(281) 491-0426
Mailing address
13811 MURPHY RD, STAFFORD, TX 77477-4903
(713) 772-1200
(281) 491-0426
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J4371
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0479214-01
—
TX
01
—
10018768
AMERIGROUP
TX
01
—
20033056
MEDICARE RR
TX
01
—
3974024
CIGNA
TX
01
—
5834481
AETNA
TX
Enumeration date
10/04/2006
Last updated
06/03/2019
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