Provider Demographics
NPI:1053341875
Name:MOODY, AUSTIN RANDALL II (MD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:RANDALL
Last Name:MOODY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:218 QUINLAN STREET
Mailing Address - Street 2:PMB #373
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-285-4096
Mailing Address - Fax:830-896-3310
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:NEURO SECTION, MAIL STOP 111D
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:830-285-4096
Practice Address - Fax:830-896-3310
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG36202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034299003Medicaid
TX40143365OtherDEA CERTIFICATE
C19503Medicare UPIN
TX034299003Medicaid
TX00877ZMedicare PIN