Healthcare Provider Details

I. General information

NPI: 1063488864
Provider Name (Legal Business Name): DURWARD TROY MOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TROY MOON MD

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-9511
  • Fax:
Mailing address:
  • Phone: 504-899-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number0000042693
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD.025870
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: