Provider Demographics
NPI:1043344179
Name:PEDRO MORA MDPC
Entity Type:Organization
Organization Name:PEDRO MORA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-363-6674
Mailing Address - Street 1:1009 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-3045
Mailing Address - Country:US
Mailing Address - Phone:337-363-6674
Mailing Address - Fax:337-363-6675
Practice Address - Street 1:1009 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-3045
Practice Address - Country:US
Practice Address - Phone:337-363-6674
Practice Address - Fax:337-363-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1183644Medicaid
LAB89810Medicare UPIN
LA1183644Medicaid