Provider Demographics
NPI:1780220855
Name:MORELAND, MARK THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:MORELAND
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:3705 S MERIDIAN STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3709
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2025-03-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant