Individual
JEFFREY KEITH MOONAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 HENNESSY BLVD, SUITE 1000, BATON ROUGE, LA 70808-4300
(225) 767-3900
(225) 214-9109
Mailing address
7777 HENNESSY BLVD, SUITE 1000, BATON ROUGE, LA 70808-4300
(225) 767-3900
(225) 214-9109
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
11825
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171514
—
LA
01
—
232758
WELLCARE
LA
01
—
2500230
UNITED HEALTHCARE
LA
01
—
4211647
AETNA
LA
Enumeration date
08/19/2005
Last updated
07/09/2007
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