Provider Demographics
NPI:1881693364
Name:MOQUIN, THOMAS FRANCIS (CRNA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:MOQUIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 RAINBOW DR
Mailing Address - Street 2:PMB 10707
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-2007
Mailing Address - Country:US
Mailing Address - Phone:503-970-6426
Mailing Address - Fax:
Practice Address - Street 1:33316 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-4318
Practice Address - Country:US
Practice Address - Phone:503-970-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200060013CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL430067146Medicaid
OR04188Medicaid
OR107328Medicare ID - Type Unspecified
OR04188Medicaid