Individual
DR. CLINTON T MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2711 E 5TH ST, DULUTH, MN 55812
(218) 724-0649
Mailing address
2711 E 5TH ST, DULUTH, MN 55812-1538
(218) 724-0649
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25367
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30451200
—
WI
Enumeration date
10/20/2005
Last updated
01/20/2015
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