Individual
MANUEL R. MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34332
MN
208C00000X
Colon & Rectal Surgery Physician
34332
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005226400
—
MN
01
—
1700230
MEDICA
MN
01
—
62D72MO
BCBSM
MN
Enumeration date
03/08/2006
Last updated
12/27/2022
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