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General NPI Number Information
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NPI Number | 1740504042
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Entity Type | Organization
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Legal Business Name | TIMOTHY J. MOONEY, M.D., L.L.C.
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 42333 DELUXE PLZ SUITE 7
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City | HAMMOND
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State | LA
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Zip | 70403-1239
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Country | US
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Telephone | 985-345-2555
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Fax | 985-345-2837
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Provider Business Mailing Address
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Address Line | 807 EDEN OAKS DR
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City | PONCHATOULA
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State | LA
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Zip | 70454-6389
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Country | US
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Telephone | 985-345-2555
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Fax | 985-345-2837
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY JOSEPH MOONEY
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Credential | M.D.
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Telephone | 985-345-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD.019931
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License Number State | LA
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