Provider Demographics
NPI:1396884045
Name:MORAN, JAMES JOSEPH (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:MORAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 POTOMAC CIR UNIT 290
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6796
Mailing Address - Country:US
Mailing Address - Phone:303-341-0722
Mailing Address - Fax:303-341-0832
Practice Address - Street 1:830 POTOMAC CIR UNIT 290
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6796
Practice Address - Country:US
Practice Address - Phone:303-341-0722
Practice Address - Fax:303-341-0832
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807585Medicare PIN
COQ77009Medicare UPIN