Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2003-0491 | NM |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | Q2026 | TX |
NPI | 1053328013 |
---|---|
Provider Name | Lisa Moore |
First Address | Albuquerque, NM 87109-1218 |
Second Address | El Paso, TX 79905-2707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 03/02/2021 |