Individual
MARY L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
105 E HACKBERRY ST, PEARSALL, TX 78061-4412
(830) 334-3670
(830) 334-3672
Mailing address
151 ENCINO DRIVE, PEARSALL, TX 78061
(830) 334-3670
(830) 334-3672
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02513
TX
Other
Enumeration date
07/06/2006
Last updated
03/24/2011
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