Provider Demographics
NPI:1982604419
Name:MOORE, PATRICK DEVINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DEVINCENT
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-0070
Mailing Address - Country:US
Mailing Address - Phone:337-706-8986
Mailing Address - Fax:337-706-8714
Practice Address - Street 1:3414 MOSS ST
Practice Address - Street 2:SUITE F&G
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6107
Practice Address - Country:US
Practice Address - Phone:337-706-8986
Practice Address - Fax:337-706-8714
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4A422Medicare ID - Type Unspecified
H15644Medicare UPIN