MEDICARE: DR. JOHN A MORAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	20816	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180001387	OTHER	MN	INDIVIDUAL MEDICARE NUMBER GRAND RAPIDS
2	180001388	OTHER	MN	INDIVIDUAL MEDICARE NUMBER HIBBING
3	C02738	OTHER	MN	MEDICARE PROVIDER NUMBER HIBBING
4	C08247	OTHER	MN	MEDICARE GRAND RAPIDS PROVIDER NUMBER

General Provider Information

NPI Number	:	1700879756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A MORAN M.D.

Provider Business Mailing Address
First Line	:	1542 GOLF COURSE RD
Second Line	:	SUITE 201
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744
Country	:	US
Telephone Number	:	218-326-3433
Fax Number	:	218-326-3435

Provider Business Practice Location Address
First Line	:	1542 GOLF COURSE RD
Second Line	:	SUITE 201
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744
Country	:	US
Telephone Number	:	218-326-3433
Fax Number	:	218-326-3435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	01/07/2010

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Directions to “ DR. JOHN A MORAN M.D.” Practice Location

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