MEDICARE: DR. JULIE A 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	MD00036575	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124925	OTHER	WA	L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558367961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A MORAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1529
Second Line	:	905 EAST D STREET
City	:	DEER PARK
State	:	WA
Zip	:	99006-1529
Country	:	US
Telephone Number	:	509-276-5005
Fax Number	:	509-276-7785

Provider Business Practice Location Address
First Line	:	905 EAST D STREET
Second Line	:
City	:	DEER PARK
State	:	WA
Zip	:	99006-1529
Country	:	US
Telephone Number	:	509-276-5005
Fax Number	:	509-276-7785

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/18/2018

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