1225334535 NPI number — DR. TAYLOR LAWRENCE MOORE D.O.

Table of content: DR. TAYLOR LAWRENCE MOORE D.O. (NPI 1225334535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225334535 NPI number — DR. TAYLOR LAWRENCE MOORE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
TAYLOR
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225334535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/20/2020
NPI Reactivation Date:
05/08/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 MOURSUND AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-5389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-799-5033
Provider Business Mailing Address Fax Number:
713-797-5982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 MOURSUND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-5389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-799-5033
Provider Business Practice Location Address Fax Number:
713-797-5982
Provider Enumeration Date:
02/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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