Healthcare Provider Details

I. General information

NPI: 1578709085
Provider Name (Legal Business Name): EUGENE WINFORD MOYERS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 SW CEDAR HILLS BLVD SUITE 203
BEAVERTON OR
97005-2027
US

IV. Provider business mailing address

3800 SW CEDAR HILLS BLVD SUITE 203
BEAVERTON OR
97005-2027
US

V. Phone/Fax

Practice location:
  • Phone: 503-330-7948
  • Fax:
Mailing address:
  • Phone: 503-330-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14308
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: