Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO190575 | OR |
NPI | 1508203332 |
---|---|
Provider Name | Dr. Brian Moreaux |
First Address | Ashland, OR 97520-2125 |
Second Address | Ashland, OR 97520-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 19/04/2019 |