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NPI Code Detail

MEDICARE: JOHN PAUL MORAN

MEDICARE: JOHN PAUL MORAN
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1083368070
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PAUL MORAN
Provider Business Mailing Address
First Line : 1102 E ST
Second Line :
City : ANCHORAGE
State : AK
Zip : 99501-4477
Country : US
Telephone Number : 907-903-3015
Fax Number :
Provider Business Practice Location Address
First Line : 1102 E ST
Second Line :
City : ANCHORAGE
State : AK
Zip : 99501-4477
Country : US
Telephone Number : 907-903-3015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2022
Last Update Date : 02/08/2022

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