Individual provider · Type 1 NPI
Tatum Marie Moog
Medical Physician Assistant · Plano, TX
NPI number
1366225161
Active
Practice location
4001 W 15th St Ste 445
Plano, TX 75093-5845
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA19566 |
Medical Physician Assistant: Definition to come...
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About NPI 1366225161
Tatum Marie Moog's National Provider Identifier is 1366225161, issued on Aug 15, 2023. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Plano, TX. The record was last updated on Aug 27, 2026.