Individual
GERALD CLINTON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
760 N SHILOH RD STE 602, GARLAND, TX 75042-5714
(972) 272-4463
(972) 272-7137
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
D9577
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770531121
—
TX
01
—
861510
MEDICARE PTAN
TX
01
—
861512
MEDICARE PTAN
TX
Enumeration date
05/05/2006
Last updated
11/13/2023
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