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NPI Code Detail

MEDICARE: MRS. LORI LYNN MOOG

MEDICARE: MRS. LORI LYNN MOOG
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
1171W00000XContractor

General Provider Information

NPI Number : 1780898734
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI LYNN MOOG
Provider Business Mailing Address
First Line : 1258 LEA RANCH DR.
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012
Country : US
Telephone Number : 505-373-0850
Fax Number :
Provider Business Practice Location Address
First Line : 1258 LEA RANCH DR.
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012
Country : US
Telephone Number : 505-373-0850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. LORI LYNN MOOG ” Practice Location

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