Individual
DR. EUGENE RICHARD MOAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
1521 N BEAVER ST, FLAGSTAFF, AZ 86001-1484
(928) 523-9604
Mailing address
42 PINE CONE DR, FLAGSTAFF, AZ 86001-9605
(928) 523-9604
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
927
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0133340
BLUE CROSS/BLUE SHIELD OF
AZ
Enumeration date
10/11/2006
Last updated
07/08/2007
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