Healthcare Provider Details

I. General information

NPI: 1306809645
Provider Name (Legal Business Name): ALAN MORDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

1 HARPST STREET HSU STUDENT HEALTH CENTER
ARCATA CA
95521
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax: 707-269-3753
Mailing address:
  • Phone: 707-826-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG40616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: