Provider Demographics
NPI:1114922325
Name:MORAN, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4201 MARATHON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3436
Mailing Address - Country:US
Mailing Address - Phone:512-459-3205
Mailing Address - Fax:512-459-8590
Practice Address - Street 1:4201 MARATHON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3436
Practice Address - Country:US
Practice Address - Phone:512-459-3205
Practice Address - Fax:512-459-8590
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DV65Medicare PIN
TXC19572Medicare UPIN