Provider Demographics
NPI:1740504042
Name:TIMOTHY J. MOONEY, M.D., L.L.C.
Entity type:Organization
Organization Name:TIMOTHY J. MOONEY, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-345-2555
Mailing Address - Street 1:807 EDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6389
Mailing Address - Country:US
Mailing Address - Phone:985-345-2555
Mailing Address - Fax:985-345-2837
Practice Address - Street 1:42333 DELUXE PLZ
Practice Address - Street 2:SUITE 7
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1239
Practice Address - Country:US
Practice Address - Phone:985-345-2555
Practice Address - Fax:985-345-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019931207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty