MEDICARE: DR. PATRICK DEVINCENT 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
1	207Q00000X	Family Medicine Physician	024344	LA

General Provider Information

NPI Number	:	1982604419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK DEVINCENT MOORE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	CARENCRO
State	:	LA
Zip	:	70520-0070
Country	:	US
Telephone Number	:	337-706-8986
Fax Number	:	337-706-8714

Provider Business Practice Location Address
First Line	:	3414 MOSS ST
Second Line	:	SUITE F&G
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-6107
Country	:	US
Telephone Number	:	337-706-8986
Fax Number	:	337-706-8714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	10/05/2011

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