Provider Demographics
NPI:1578510442
Name:MOQUIST, DALE C (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:C
Last Name:MOQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14023 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3550
Mailing Address - Country:US
Mailing Address - Phone:281-325-4100
Mailing Address - Fax:281-325-4292
Practice Address - Street 1:14023 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3550
Practice Address - Country:US
Practice Address - Phone:281-325-4100
Practice Address - Fax:281-325-4292
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046443005Medicaid
TX046443004Medicaid
TX046443004Medicaid
TX046443005Medicaid
TX8C1634Medicare ID - Type Unspecified