Provider Demographics
NPI:1003141193
Name:MOORE, LAURIE JO (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:JO
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 CHATSWOOD GROVE
Mailing Address - Street 2:BIRKENHEAD
Mailing Address - City:AUCKLAND
Mailing Address - State:NORTH SHORE
Mailing Address - Zip Code:0626
Mailing Address - Country:NZ
Mailing Address - Phone:649-480-7617
Mailing Address - Fax:649-570-6520
Practice Address - Street 1:15 PLEASANT VIEW ROAD
Practice Address - Street 2:PANMURE
Practice Address - City:AUCKLAND
Practice Address - State:EAST AUCKLAND
Practice Address - Zip Code:1072
Practice Address - Country:NZ
Practice Address - Phone:649-570-6519
Practice Address - Fax:649-570-6520
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA600565312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC94449Medicare UPIN