Individual
LARRY L MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11211 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-7787
(503) 659-0880
(503) 513-7425
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 659-0880
(503) 513-7425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO15179
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202942
WA LABOR & INDUSTRIES
WA
05
—
159723
—
OR
Enumeration date
04/13/2006
Last updated
03/17/2010
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