Healthcare Provider Details

I. General information

NPI: 1225334535
Provider Name (Legal Business Name): TAYLOR LAWRENCE MOORE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date: 04/20/2020
Reactivation Date: 05/08/2020

III. Provider practice location address

1331 MOURSUND AVENUE
HOUSTON TX
77030-5389
US

IV. Provider business mailing address

1331 MOURSUND AVENUE
HOUSTON TX
77030-5389
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-5033
  • Fax: 713-797-5982
Mailing address:
  • Phone: 713-799-5033
  • Fax: 713-797-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: