Provider Demographics
NPI:1184645160
Name:MOFFAT, LAURA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELLEN
Last Name:MOFFAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:ROBESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 19TH STREET
Mailing Address - Street 2:SUITE 509
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1853
Mailing Address - Country:US
Mailing Address - Phone:865-524-3208
Mailing Address - Fax:865-522-4322
Practice Address - Street 1:501 19TH STREET
Practice Address - Street 2:SUITE 509
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1853
Practice Address - Country:US
Practice Address - Phone:865-524-3208
Practice Address - Fax:865-522-4322
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37192207V00000X
TNMD0000037192207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886391Medicaid
TN3886391Medicaid
TNH89408Medicare UPIN
H89408Medicare UPIN