Healthcare Provider Details

I. General information

NPI: 1003127085
Provider Name (Legal Business Name): SARAH T. MORAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 OLIVE ST
SENECA MO
64865-9247
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-776-5900
  • Fax: 417-776-5901
Mailing address:
  • Phone: 417-776-5900
  • Fax: 417-776-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEP6294
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2013013924
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: