Healthcare Provider Details

I. General information

NPI: 1164612537
Provider Name (Legal Business Name): ANDREW JOSEPH MOODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY BH 634
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1514 JEFFERSON HWY BH 634
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4096
  • Fax: 504-842-3193
Mailing address:
  • Phone: 504-842-4000
  • Fax: 504-842-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.203946
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD.203946
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: