Provider Demographics
NPI:1265640809
Name:MORITZ, ANDREW JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:MORITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2399
Mailing Address - Country:US
Mailing Address - Phone:318-425-8701
Mailing Address - Fax:318-424-0376
Practice Address - Street 1:2449 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2399
Practice Address - Country:US
Practice Address - Phone:318-425-8701
Practice Address - Fax:318-424-0376
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205019207X00000X
390200000X
VA0116018545390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program