Provider Demographics
NPI:1710152541
Name:MOORE, UZOMA BERTRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:UZOMA
Middle Name:BERTRAM
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11111 N HARRELLS FERRY RD
Mailing Address - Street 2:# 137
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8389
Mailing Address - Country:US
Mailing Address - Phone:225-270-1255
Mailing Address - Fax:225-367-1045
Practice Address - Street 1:11111 N. HARRELLS FERRY RD.
Practice Address - Street 2:# 137
Practice Address - City:BATON
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-270-1255
Practice Address - Fax:225-367-1045
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2016-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.204952207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073148Medicaid