Healthcare Provider Details

I. General information

NPI: 1710977822
Provider Name (Legal Business Name): LAURA M MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA M. ROWLAND MD

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 PIPER STREET SUITE T4-054
ANCHORAGE AK
99508
US

IV. Provider business mailing address

3841 PIPER STREET SUITE T4-054
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-6228
  • Fax: 907-562-6868
Mailing address:
  • Phone: 907-562-6228
  • Fax: 907-562-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number101511
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number101511
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier12268
Identifier TypeOTHER
Identifier StateMT
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: