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General NPI Number Information
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NPI Number | 1275030850
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Entity Type | Individual
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Provider Name | LAURENCE NICHOLAS MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 191 N SUNRISE WAY
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5201
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Country | US
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Telephone | 760-778-2210
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Fax | 778-221-4760
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Provider Business Mailing Address
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Address Line | 191 N SUNRISE WAY
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5201
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Country | US
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Telephone | 760-778-2210
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Fax | 760-320-8241
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 81814-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD200222
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A177529
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License Number State | CA
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