Individual
MARIE ELISE MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NE NEFF RD, BEND, OR 97701-6015
(754) 706-6892
(541) 706-6813
Mailing address
30 N 1900 E RM 4C116, SALT LAKE CITY, UT 84132-0002
(801) 581-7606
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11405445-1205
UT
Other
Enumeration date
04/07/2018
Last updated
09/02/2022
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