Moffett, Larry L

Moffett, Larry L is an individual health care provider with primary practice located at 11211 Se Sunnyside Rd , Clackamas OR 97015-7787. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Moffett, Larry L can be contacted via phone (503) 659-0880.

Contact Information

Primary practice address
11211 Se Sunnyside Rd Clackamas OR 97015-7787
Phone: (503) 659-0880
Fax: (503) 513-7425
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X DO15179 Oregon

Profile Details

NPI number 1194789453
LBN Legal business name Moffett, Larry L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Mar 17th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194789453 NPPES
Washington Other 0202942 WA LABOR & INDUSTRIES
Washington MEDICAID 159723 WA LABOR & INDUSTRIES

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