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NPI Code Detail

MEDICARE: DR. LISA ANN MORAN M.D.

MEDICARE: DR. LISA ANN 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
12084P0800XPsychiatry PhysicianMD24266OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154399723
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA ANN MORAN M.D.
Provider Business Mailing Address
First Line : 2225 CHALLENGER WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-5441
Country : US
Telephone Number : 707-565-4970
Fax Number : 707-565-5183
Provider Business Practice Location Address
First Line : 2225 CHALLENGER WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-5441
Country : US
Telephone Number : 707-565-4970
Fax Number : 707-565-5183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 12/26/2017

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Directions to “ DR. LISA ANN MORAN M.D.” Practice Location

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