Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD12774 | OR |
Y | 207RI0011X | Interventional Cardiology | MD12774 | OR |
NPI | 1023026622 |
---|---|
Provider Name | Dr. Mark G Moran |
First Address | Medford, OR 97504-4314 |
Second Address | Medford, OR 97504-4314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 14/11/2016 |