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NPI Code Detail

MEDICARE: DR. STEPHEN PATRICK MOON M.D.

MEDICARE: DR. STEPHEN PATRICK MOON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianMD17858OR

General Provider Information

NPI Number : 1003890997
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN PATRICK MOON M.D.
Provider Business Mailing Address
First Line : 16788 SW SARALA ST
Second Line :
City : ALOHA
State : OR
Zip : 97007-6572
Country : US
Telephone Number : 503-380-1641
Fax Number :
Provider Business Practice Location Address
First Line : 3838 PACIFIC AVE
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2224
Country : US
Telephone Number : 503-992-0288
Fax Number : 503-359-4742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2005
Last Update Date : 07/25/2013

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