Individual
DONALD E MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN OTC
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4541
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4541
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
083026191RN
OR
163WX0800X
Orthopedic Registered Nurse
930064
OR
374700000X
Technician
Primary
930064 OT-SC
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
GROUP NPI NUMBER
OR
01
—
930635514
GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
02/23/2007
Last updated
03/23/2010
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