Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Jackson T Moran

Individual provider Emergency Medicine Physician · NPI 1104574680

Jackson T Moran practises Emergency Medicine in Waconia, Minnesota. Graduated from University of Chicago, Pritzker School of Medicine in 2023, 3 years ago. Licensed in Minnesota.

Years since qualifying
3
Trained at
University of Chicago, Pritzker School of Medicine
Licensed in
MN
In the registry since
2022
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Practice location Address checks out

500 S Maple St
Waconia, MN 55387-1791
Phone: (952) 777-5553
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 82147 (MN)

Record details

NPI number1104574680
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 14, 2022
Last updated in NPPESSeptember 24, 2026
Certification dateSeptember 24, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolUNIVERSITY OF CHICAGO, PRITZKER SCHOOL OF MEDICINE
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Waconia