Individual
CLAUDIA LAFAYE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1668 W PEACE ST, CANTON, MS 39046-5332
(601) 859-5213
(601) 859-8771
Mailing address
PO BOX 588, CANTON, MS 39046-0588
(601) 859-5213
(601) 859-8771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TPA0015
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03030532
—
MS
01
—
TPA0015
STATE LICENSE
MS
Enumeration date
01/15/2008
Last updated
04/17/2008
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