1922292754 NPI number — DR. CARRIE E DE MOOR MD

Table of content: DR. CARRIE E DE MOOR MD (NPI 1922292754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922292754 NPI number — DR. CARRIE E DE MOOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE MOOR
Provider First Name:
CARRIE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARRICK
Provider Other First Name:
CARRIE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922292754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 TOWN AND COUNTRY BLVD STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-208-5297
Provider Business Mailing Address Fax Number:
214-260-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 PAXTON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-815-4142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  17374 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: M6098 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43603092 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189459401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189459406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8W0183 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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