Individual
STACEY DENISE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1550 FIRST COLONY BLVD, SUGAR LAND, TX 77479-4000
(281) 275-6065
Mailing address
20211 CYPRESSWOOD ESTATES RUN APT 4718, SPRING, TX 77373-3295
(832) 496-4855
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M8193
TX
2086S0120X
Pediatric Surgery Physician
036139932
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196912302
—
TX
01
—
8CA598
BCBS
TX
Enumeration date
12/07/2007
Last updated
10/14/2020
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