Provider Demographics
NPI:1154471308
Name:BUDDEN, MOIR M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOIR
Middle Name:M
Last Name:BUDDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2804 SE STEELE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4525
Mailing Address - Country:US
Mailing Address - Phone:503-654-3108
Mailing Address - Fax:503-232-2164
Practice Address - Street 1:2804 SE STEELE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4525
Practice Address - Country:US
Practice Address - Phone:503-654-3108
Practice Address - Fax:503-232-2164
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10495208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004945Medicaid
ORR0000BHHZFMedicare PIN
OR004945Medicaid