Provider Demographics
NPI:1316948573
Name:MOORE, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3909 LAPALCO BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2302
Mailing Address - Country:US
Mailing Address - Phone:504-391-7337
Mailing Address - Fax:504-398-7259
Practice Address - Street 1:4225 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4338
Practice Address - Country:US
Practice Address - Phone:504-391-7337
Practice Address - Fax:504-398-7259
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA0080062080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1045411Medicaid