Provider Demographics
NPI:1871888545
Name:MOORE, MILTON RAHMON (MD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:RAHMON
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1314 E SONTERRA BLVD STE 2201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4287
Mailing Address - Country:US
Mailing Address - Phone:210-496-5792
Mailing Address - Fax:210-496-7601
Practice Address - Street 1:2632 BROADWAY ST STE 201N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1145
Practice Address - Country:US
Practice Address - Phone:210-226-0040
Practice Address - Fax:210-226-0050
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039988207R00000X
TXP5691207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine