Provider Demographics
NPI:1326241043
Name:VIVIAN MOISE MD PC
Entity Type:Organization
Organization Name:VIVIAN MOISE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-747-5242
Mailing Address - Street 1:511 S PINE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1347
Mailing Address - Country:US
Mailing Address - Phone:509-747-5242
Mailing Address - Fax:509-747-5430
Practice Address - Street 1:511 S PINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1347
Practice Address - Country:US
Practice Address - Phone:509-747-5242
Practice Address - Fax:509-747-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000236742081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB28405Medicare ID - Type UnspecifiedGROUP NUMBER