Provider Demographics
NPI:1407911100
Name:MORAN, STANFORD MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:MARK
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 ORINDA VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-1234
Mailing Address - Country:US
Mailing Address - Phone:510-867-5876
Mailing Address - Fax:925-317-3956
Practice Address - Street 1:55 ORINDA VIEW RD
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-1234
Practice Address - Country:US
Practice Address - Phone:510-867-5876
Practice Address - Fax:925-317-3956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG046555207RN0300X, 208U00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology