Provider Demographics
NPI:1942687389
Name:MORAN, DANIEL MARTIN
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARTIN
Last Name:MORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3446
Mailing Address - Country:US
Mailing Address - Phone:231-760-5036
Mailing Address - Fax:231-722-3999
Practice Address - Street 1:19 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3311
Practice Address - Country:US
Practice Address - Phone:231-728-3117
Practice Address - Fax:231-722-3999
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker