Provider Demographics
NPI:1164561155
Name:MORAN, PATRICK JAMES (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:MORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:2935 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-8931
Practice Address - Country:US
Practice Address - Phone:509-837-0070
Practice Address - Fax:509-837-0690
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM07R2006207Q00000X
WAOP60145271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008267Medicaid
WA0283490OtherLABOR & INDUSTRIES
WA0283490OtherLABOR & INDUSTRIES
WAAB38059Medicare Oscar/Certification