Individual
LAURA G MOORE-FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5707 JENNY LIND RD, FORT SMITH, AR 72908-7435
(479) 452-9416
(479) 484-0827
Mailing address
PO BOX 3887, FORT SMITH, AR 72913-3887
(479) 452-9416
(479) 484-0827
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E0123
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100102480A
—
OK
05
—
125294001
—
AR
01
—
5J379
BC-BS
—
Enumeration date
01/23/2006
Last updated
04/30/2019
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