Provider Demographics
NPI:1063512358
Name:MORIAH, KAREN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:MORIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:BENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:SELLS PHS INDIAN HOSPITAL
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634
Mailing Address - Country:US
Mailing Address - Phone:520-383-7200
Mailing Address - Fax:520-383-7343
Practice Address - Street 1:BOX 548
Practice Address - Street 2:SELLS PHS INDIAN HOSPITAL
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-383-7200
Practice Address - Fax:520-383-7343
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHS000Medicare UPIN