| Doctor Name: | MARY L MOORE |
| NPI Number: | 1770514614 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA C |
| License Number: | PA02513 |
| Business Practice Address: | 105 E Hackberry St Pearsall, TX - 780614412 |
| Business Phone Number: | 8303343670 |
| Business Fax Number: | 8303343672 |
| Mailing Address: | 151 Encino Drive, PEARSALL |
| State: | TX |
| Postal Code: | 78061 |
| Phone Number: | 8303343670 |
| Fax Number: | 8303343672 |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 03/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA02513 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |