Provider Demographics
NPI:1023038395
Name:MOE, KARL O
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:O
Last Name:MOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2745
Mailing Address - Country:US
Mailing Address - Phone:319-277-4383
Mailing Address - Fax:
Practice Address - Street 1:324 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2745
Practice Address - Country:US
Practice Address - Phone:319-277-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32948103TC0700X
IA1075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87201AOtherBLUE CROSS BLUE SHIELD
TX8G3674Medicare ID - Type Unspecified