Provider Demographics
NPI:1710977822
Name:MOORE, LAURA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3841 PIPER STREET
Mailing Address - Street 2:SUITE T4-054
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-562-6228
Mailing Address - Fax:907-562-6868
Practice Address - Street 1:3841 PIPER STREET
Practice Address - Street 2:SUITE T4-054
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-562-6228
Practice Address - Fax:907-562-6868
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101511207KA0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12268OtherLICENSE