Provider Demographics
NPI:1922041565
Name:MOORE-GUILLAUME, SEVETRI (MD)
Entity Type:Individual
Prefix:DR
First Name:SEVETRI
Middle Name:
Last Name:MOORE-GUILLAUME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 880
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3908
Mailing Address - Fax:318-212-3909
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 880
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3908
Practice Address - Fax:318-212-3909
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016859207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1329517Medicaid
LAP00382860OtherRR MEDICARE
LAP00382860OtherRR MEDICARE
LAB89286Medicare UPIN
LA5H451CQ62Medicare PIN