Provider Demographics
NPI:1437327640
Name:MORAN, KRISTINE L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-746-5001
Mailing Address - Fax:520-573-9607
Practice Address - Street 1:3939 S PARK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1635
Practice Address - Country:US
Practice Address - Phone:520-746-5001
Practice Address - Fax:520-573-9607
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ20212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ251934Medicaid
120354Medicare PIN