Provider Demographics
NPI:1174563878
Name:MOELLER, LORALIE DAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:LORALIE
Middle Name:DAVIS
Last Name:MOELLER
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 1:90 HEALTH PARK DRIVE
Mailing Address - Street 2:290
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9586
Mailing Address - Country:US
Mailing Address - Phone:303-439-8910
Mailing Address - Fax:303-439-9134
Practice Address - Street 1:90 HEALTH PARK DRIVE
Practice Address - Street 2:290
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9586
Practice Address - Country:US
Practice Address - Phone:303-439-8910
Practice Address - Fax:303-439-9134
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46155333Medicaid
COC808245OtherLEGACY NUMBER
COC808245OtherLEGACY NUMBER