Healthcare Provider Details

I. General information

NPI: 1285651752
Provider Name (Legal Business Name): ERIC J MOEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 PACIFIC BLVD SW STE 102
ALBANY OR
97321-1475
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 541-924-2873
  • Fax: 541-844-3732
Mailing address:
  • Phone: 877-708-1119
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00565
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: