Provider Demographics
NPI:1184693020
Name:MONETA, MICHAEL D (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:MONETA
Suffix:
Gender:M
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:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4008
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:503-372-2755
Practice Address - Street 1:11782 SW BARNES RD
Practice Address - Street 2:BLDG C #200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-906-4300
Practice Address - Fax:503-906-4333
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18011207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR051453Medicaid
OR840285000OtherREGENCE BCBSO
ORR121651Medicare PIN
E63558Medicare UPIN