Provider Demographics
NPI:1265433890
Name:MOODY, LAURA OSBORN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:OSBORN
Last Name:MOODY
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 1:3495 HACKS CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8803
Mailing Address - Country:US
Mailing Address - Phone:901-526-7444
Mailing Address - Fax:901-526-0791
Practice Address - Street 1:3495 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8803
Practice Address - Country:US
Practice Address - Phone:901-526-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31880207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology