Individual
LAUREN GILLIS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13960 FLORIDA BOULEVARD, LIVINGSTON, LA 70754
(225) 686-0158
(225) 686-9965
Mailing address
8490 PICARDY AVE, BLDG 200, BATON ROUGE, LA 70809-3731
(225) 237-1754
(225) 237-1722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.203904
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1945325
—
LA
01
—
4R220B116
MEDICARE PTAN
LA
Enumeration date
03/20/2009
Last updated
09/23/2014
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