Healthcare Provider Details

I. General information

NPI: 1841515061
Provider Name (Legal Business Name): SEAN MICHAEL MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 BROADWAY ST
NEW ORLEANS LA
70118-5240
US

IV. Provider business mailing address

1017 BROADWAY ST
NEW ORLEANS LA
70118-5240
US

V. Phone/Fax

Practice location:
  • Phone: 650-796-1926
  • Fax:
Mailing address:
  • Phone: 650-796-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC174001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberC174001
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberC174001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: