Basic Information
| Provider Information | |||||||||
| NPI: | 1972916419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOYNIHAN | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 VETERANS DR SW | ||||||||
| Address2: | BUILDING 2, 2ND FLOOR | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535831234 | ||||||||
| FaxNumber: | 2535832315 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 VETERANS DR SW | ||||||||
| Address2: | BUILDING 2, 2ND FLOOR | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535831234 | ||||||||
| FaxNumber: | 2535832315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2014 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 287825 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0960827815 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.