Provider Demographics
NPI:1578312054
Name:MOORE DERMATOLOGY PLLC
Entity type:Organization
Organization Name:MOORE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:OMNI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLUNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MMSC, MPH
Authorized Official - Phone:713-741-3376
Mailing Address - Street 1:2525 W BELLFORT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 W BELLFORT AVE STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5024
Practice Address - Country:US
Practice Address - Phone:713-741-3376
Practice Address - Fax:713-741-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty