MEDICARE: LLOYD TETSUO MORITA MD

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	207R00000X	Internal Medicine Physician	MDO8923	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001 373 000	OTHER	OR	BCBS

General Provider Information

NPI Number	:	1841366317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD TETSUO MORITA MD

Provider Business Mailing Address
First Line	:	1002 N BOONES FERRY RD
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-9602
Country	:	US
Telephone Number	:	503-981-9526
Fax Number	:	503-982-3814

Provider Business Practice Location Address
First Line	:	1002 N BOONES FERRY RD
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-9602
Country	:	US
Telephone Number	:	503-981-9526
Fax Number	:	503-982-3814

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/03/2008

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