Provider Demographics
NPI:1831224542
Name:MOUDREE, MARCIA K (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:K
Last Name:MOUDREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:K
Other - Last Name:MAGNUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4065 VIA PALO VERDE LAGO
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3219
Mailing Address - Country:US
Mailing Address - Phone:406-439-6840
Mailing Address - Fax:619-445-6833
Practice Address - Street 1:4065 VIA PALO VERDE LAGO
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3219
Practice Address - Country:US
Practice Address - Phone:406-439-6840
Practice Address - Fax:619-445-6833
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43849207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology