Active NPI
Bridgette Moore
- Phlebology Physician
- Garland, TX
National Provider Identifier
1639807894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebology Physician
- License
- 22-3000
- Practice address
- 2717 Patricia LN Apt a
Garland, TX 75041-2610 - Phone
- (469) 550-5506
- NPI assigned
- Aug 15, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebology Physician | 202K00000X | 22-3000 | TX | Primary |
Addresses
Primary practice location
2717 Patricia LN Apt a
Garland, TX 75041-2610
Mailing address
10233 E Northwest Hwy Unit 38422
Dallas, TX 75238-4458
Phone (214) 928-0803
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22-3000 | TX | MD | Phlebology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660521600000",
"number": "1639807894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10233 E NORTHWEST HWY UNIT 38422",
"city": "DALLAS",
"state": "TX",
"postal_code": "752384458",
"telephone_number": "214-928-0803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2717 PATRICIA LN APT A",
"city": "GARLAND",
"state": "TX",
"postal_code": "750412610",
"telephone_number": "469-550-5506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "BRIDGETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-15",
"last_updated": "2022-08-15",
"certification_date": "2022-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "202K00000X",
"taxonomy_group": "",
"desc": "Phlebology",
"state": "TX",
"license": "22-3000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.