Provider Demographics
NPI:1518993310
Name:MOORE, LASHONDA (DPM)
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FORT DALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-1502
Mailing Address - Country:US
Mailing Address - Phone:334-382-1400
Mailing Address - Fax:
Practice Address - Street 1:220 FORT DALE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-1502
Practice Address - Country:US
Practice Address - Phone:334-382-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051533097OtherBC MONTGOMERY OFFICE
AL051532094OtherBC CEDARS ASSISTED LIVING
AL890014860Medicaid
ALP00289903OtherRAILROAD MEDICARE
AL051532095OtherBC ELMCROFT ASSISTED LIVI
AL890014840Medicaid
AL890014890Medicaid
AL051532088OtherBC GREENVILLE OFFICE
AL051532089OtherBC SNF SUNBRIDGE
AL051532090OtherBC SNF BELLMONT ASSISTED
AL051532091OtherBC HILLABER TOWERS ALEX C
AL891011570Medicaid
AL891011610Medicaid
AL051533098OtherBC CLANTON OFFICE
AL891011600Medicaid
AL891011620Medicaid
AL051532092OtherBC COUNTY CLUB MANOR WETU
AL890014810Medicaid
AL891011570Medicaid
AL051557098Medicare ID - Type UnspecifiedMCR ALL LOCATIONS
AL890014840Medicaid