Provider Demographics
NPI:1225334535
Name:MOORE, TAYLOR LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:LAWRENCE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MOURSUND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5389
Mailing Address - Country:US
Mailing Address - Phone:713-799-5033
Mailing Address - Fax:713-797-5982
Practice Address - Street 1:1331 MOURSUND AVENUE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:713-799-5033
Practice Address - Fax:713-797-5982
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2020-05-19
Deactivation Date:2020-04-20
Deactivation Code:
Reactivation Date:2020-05-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program