Provider Demographics
NPI:1063488864
Name:MOON, DURWARD TROY (MD)
Entity Type:Individual
Prefix:DR
First Name:DURWARD
Middle Name:TROY
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TROY
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5798
Mailing Address - Country:US
Mailing Address - Phone:504-899-9511
Mailing Address - Fax:
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5798
Practice Address - Country:US
Practice Address - Phone:504-899-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000426932080P0208X, 2080P0208X
LAMD.0258702080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABM9034911OtherFEDERAL DEA