Provider Demographics
NPI:1013175611
Name:CHARLES J MORAN MD INC
Entity Type:Organization
Organization Name:CHARLES J MORAN MD INC
Other - Org Name:PASO ROBLES URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-226-0902
Mailing Address - Street 1:1763 RAMADA DRIVE
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446
Mailing Address - Country:US
Mailing Address - Phone:805-226-0902
Mailing Address - Fax:
Practice Address - Street 1:1763 RAMADA DRIVE
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446
Practice Address - Country:US
Practice Address - Phone:805-226-0902
Practice Address - Fax:805-226-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3076452207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0245163OtherWASHINGTON STATE DOL
CA05D1091562OtherCLIA #
CA614136900OtherUSDOL
CAZZZ54744YOtherBLUE SHIELD GRP PIN
CAC3076452OtherCALIF STATE LICENSE
CA05D1091562OtherCLIA #
CAZZZ54744YOtherBLUE SHIELD GRP PIN
A89878Medicare UPIN