Individual
MRS. SUZANNE F MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CALM
Contact information
Practice address
5801 RAYBURN DR, FORT WORTH, TX 76133-3026
(682) 707-2524
(469) 660-0065
Mailing address
2321 S BELT LINE RD STE 148, GRAND PRAIRIE, TX 75051-4182
(214) 396-5288
(469) 660-0065
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20553605
DRIVER LICENSE
TX
Enumeration date
03/16/2020
Last updated
03/16/2020
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