Healthcare Provider Details

I. General information

NPI: 1962818211
Provider Name (Legal Business Name): LAMAR HOUSTON MOREE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD STE 301
MEMPHIS TN
38120-2123
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-0456
  • Fax: 901-226-0458
Mailing address:
  • Phone:
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number28751
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number63366
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: