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General NPI Number Information
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NPI Number | 1548286693
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Entity Type | Individual
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Provider Name | FORREST O MOORE III M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 1541 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-626-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 W KIRBY PL
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City | SHREVEPORT
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State | LA
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Zip | 71103-3822
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M0188
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 311893
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | M0188
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 311893
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License Number State | LA
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