Provider Demographics
NPI:1104888676
Name:MORAN, REBECCA F (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:F
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:FELDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4530 E RAY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6094
Mailing Address - Country:US
Mailing Address - Phone:480-785-4775
Mailing Address - Fax:480-785-0908
Practice Address - Street 1:4530 E RAY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6094
Practice Address - Country:US
Practice Address - Phone:480-785-4775
Practice Address - Fax:480-785-0908
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452251Medicaid
AZZ129615Medicare PIN
77269Medicare ID - Type Unspecified
G87128Medicare UPIN