Provider Demographics
NPI:1144570805
Name:MOORMAN, JAMES HERBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HERBERT
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CARMAN DR
Mailing Address - Street 2:UNIT 41
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2475
Mailing Address - Country:US
Mailing Address - Phone:503-473-6345
Mailing Address - Fax:
Practice Address - Street 1:4000 CARMAN DR
Practice Address - Street 2:UNIT 41
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2475
Practice Address - Country:US
Practice Address - Phone:503-473-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant