Provider Demographics
NPI:1154380467
Name:MORIARITY, JOSEPH T (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:MORIARITY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14688 EVERTON AVE N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6064
Mailing Address - Country:US
Mailing Address - Phone:651-326-7701
Mailing Address - Fax:651-326-1190
Practice Address - Street 1:14688 EVERTON AVE N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-6064
Practice Address - Country:US
Practice Address - Phone:651-326-7701
Practice Address - Fax:651-326-1190
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH05325Medicare UPIN