Healthcare Provider Details

I. General information

NPI: 1790719219
Provider Name (Legal Business Name): MARK D MORASCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR STE 300
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

PO BOX 281490
ATLANTA GA
30384-1490
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-3531
  • Fax: 541-222-2483
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036085648
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number18479
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD218121
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: