Individual
SHERI A. MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA
Contact information
Practice address
910 BUNTON LN, UHLAND, TX 78640-6404
(806) 787-7840
(806) 794-0125
Mailing address
PO BOX 40307, AUSTIN, TX 78704
(806) 787-7840
(806) 794-0125
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
SA0047
TX
208600000X
Surgery Physician
Primary
SA00047
TX
363AS0400X
Surgical Physician Assistant
SA0047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062JR
BLUE CROSS & BLUE SHIELD
TX
01
—
208600000X
TAXONOMY
TX
Enumeration date
11/14/2006
Last updated
08/01/2013
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