Provider Demographics
NPI:1487743696
Name:MOORE, BRIAN FRANKLIN (CPO)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:FRANKLIN
Last Name:MOORE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 COMMERCIAL SQUARE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5418
Mailing Address - Country:US
Mailing Address - Phone:985-649-2010
Mailing Address - Fax:985-847-9205
Practice Address - Street 1:172 COMMERCIAL SQ
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5418
Practice Address - Country:US
Practice Address - Phone:985-649-2010
Practice Address - Fax:985-847-9205
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1199311Medicaid
LA0158750001Medicare NSC