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NPI Code Detail

MEDICARE: LAWRENCE MOORE M.D.

MEDICARE: LAWRENCE MOORE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA24847CA

General Provider Information

NPI Number : 1104827377
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAWRENCE MOORE M.D.
Provider Business Mailing Address
First Line : PO BOX 45680
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94145-0680
Country : US
Telephone Number : 530-626-2920
Fax Number :
Provider Business Practice Location Address
First Line : 1095 MARSHALL WAY
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-5722
Country : US
Telephone Number : 530-626-2920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 01/26/2012

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