MEDICARE: WILLIAM JAMES MORAN 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
1	207Q00000X	Family Medicine Physician	E4547	TX

General Provider Information

NPI Number	:	1114922325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JAMES MORAN M.D.

Provider Business Mailing Address
First Line	:	4201 MARATHON BLVD
Second Line	:	SUITE 204
City	:	AUSTIN
State	:	TX
Zip	:	78756-3436
Country	:	US
Telephone Number	:	512-459-3205
Fax Number	:	512-459-8590

Provider Business Practice Location Address
First Line	:	4201 MARATHON BLVD
Second Line	:	SUITE 204
City	:	AUSTIN
State	:	TX
Zip	:	78756-3436
Country	:	US
Telephone Number	:	512-459-3205
Fax Number	:	512-459-8590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	05/30/2008

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