Individual
DR. LAWRENCE M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5818 W CAPITOL DR, MILWAUKEE, WI 53216-2247
(414) 449-2114
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 449-2114
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
74437-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100161086
—
WI
Enumeration date
03/25/2019
Last updated
12/08/2022
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