Individual
RICHARD BRADLEY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
Q0124
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336079405
—
TX
01
—
8EW471
BLUE CROSS BLUE SHIELD
TX
01
—
P01547909
PALMETTO GBA
TX
Enumeration date
04/06/2010
Last updated
01/25/2022
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