Individual
HALEY BROOKE MOAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10803 SE CHERRY BLOSSOM DR, PORTLAND, OR 97216-3107
(503) 261-7200
(503) 261-7226
Mailing address
911 SW 21ST AVE APT 204, PORTLAND, OR 97205-1565
(541) 519-2923
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
OR
Other
Enumeration date
09/08/2017
Last updated
09/08/2017
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