Provider Demographics
NPI:1497880355
Name:MORAN, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12101 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2651
Mailing Address - Country:US
Mailing Address - Phone:206-244-8100
Mailing Address - Fax:206-431-9142
Practice Address - Street 1:12101 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-2651
Practice Address - Country:US
Practice Address - Phone:206-244-8100
Practice Address - Fax:206-431-9142
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000046752084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA05211Medicare UPIN
WAGAB35541Medicare PIN