Provider Demographics
NPI:1194725226
Name:MOORE, FERNEY ADAMS III (MD)
Entity type:Individual
Prefix:
First Name:FERNEY
Middle Name:ADAMS
Last Name:MOORE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9000 AIRLINE HWY
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4114
Mailing Address - Country:US
Mailing Address - Phone:225-927-5480
Mailing Address - Fax:225-925-0896
Practice Address - Street 1:9000 AIRLINE HWY
Practice Address - Street 2:SUITE 620
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4114
Practice Address - Country:US
Practice Address - Phone:225-927-5480
Practice Address - Fax:225-925-0896
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14127207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1324248Medicaid
D79704Medicare UPIN
5L548Medicare ID - Type Unspecified