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Individual

AMY MARIE MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504
(210) 916-8764
Mailing address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
207P00000X
Emergency Medicine Physician
PA11886
TX
363A00000X
Physician Assistant
Primary
PA11886
TX

Other

Enumeration date
02/06/2012
Last updated
06/11/2020
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