Provider Demographics
NPI:1053590133
Name:MOELLER, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:MOELLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6300 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 680
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-661-4670
Mailing Address - Fax:713-661-4672
Practice Address - Street 1:6300 WEST LOOP S
Practice Address - Street 2:SUITE 680
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-661-4670
Practice Address - Fax:713-661-4672
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2011-03-04
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Provider Licenses
StateLicense IDTaxonomies
TXH64432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H59ZMedicare PIN