Healthcare Provider Details

I. General information

NPI: 1710152541
Provider Name (Legal Business Name): UZOMA BERTRAM MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 N. HARRELLS FERRY RD. # 137
BATON LA
70816
US

IV. Provider business mailing address

11111 N HARRELLS FERRY RD # 137
BATON ROUGE LA
70816-8389
US

V. Phone/Fax

Practice location:
  • Phone: 225-270-1255
  • Fax: 225-367-1045
Mailing address:
  • Phone: 225-270-1255
  • Fax: 225-367-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.204952
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: