Basic Information
Provider Information
NPI: 1003141193
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOORE
FirstName: LAURIE
MiddleName: JO
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 CHATSWOOD GROVE
Address2: BIRKENHEAD
City: AUCKLAND
State: NORTH SHORE
PostalCode: 0626
CountryCode: NZ
TelephoneNumber: 6494807617
FaxNumber: 6495706520
Practice Location
Address1: 15 PLEASANT VIEW ROAD
Address2: PANMURE
City: AUCKLAND
State: EAST AUCKLAND
PostalCode: 1072
CountryCode: NZ
TelephoneNumber: 6495706519
FaxNumber: 6495706520
Other Information
ProviderEnumerationDate: 10/07/2009
LastUpdateDate: 10/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X60056531WAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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