Provider Demographics
NPI:1841209129
Name:MOSER, EMILY A (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:MOSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 E 12TH ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3278
Mailing Address - Country:US
Mailing Address - Phone:541-296-1100
Mailing Address - Fax:541-236-0606
Practice Address - Street 1:1615 E 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3278
Practice Address - Country:US
Practice Address - Phone:541-296-1100
Practice Address - Fax:541-236-0606
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD167742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017249Medicaid
WA0161449Medicaid
ORR013ZBBWZAMedicare PIN
OR017249Medicaid
OR140096Medicare PIN
OR130004184Medicare PIN
OR134206Medicare PIN