Healthcare Provider Details

I. General information

NPI: 1922274828
Provider Name (Legal Business Name): BRIAN SCOTT MOYERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SE MAIN ST STE 60
PORTLAND OR
97216-2474
US

IV. Provider business mailing address

10000 SE MAIN ST STE 60
PORTLAND OR
97216-2474
US

V. Phone/Fax

Practice location:
  • Phone: 503-257-0959
  • Fax: 503-257-3457
Mailing address:
  • Phone: 503-257-0959
  • Fax: 503-257-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD168013
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA103621
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD168013
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: