Provider Demographics
NPI:1588734727
Name:MORAN, EDWARD RICHARD JR (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:RICHARD
Last Name:MORAN
Suffix:JR
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:PO BOX 382927
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38188-2927
Mailing Address - Country:US
Mailing Address - Phone:901-432-0173
Mailing Address - Fax:901-854-1585
Practice Address - Street 1:5959 PARK AVENUE
Practice Address - Street 2:ST FRANCIS HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5198
Practice Address - Country:US
Practice Address - Phone:901-432-0173
Practice Address - Fax:901-854-1585
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20894207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3076704Medicaid
3126765OtherBLUE CROSS BLUE SHIELD
3076706Medicare ID - Type Unspecified
3126765OtherBLUE CROSS BLUE SHIELD