| NPI | 1710220702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM C MOORE Physician 817-791-7501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M1948) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2017-01-25 |