Provider Demographics
NPI:1003303173
Name:MOSHER, JEREMY M (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:MOSHER
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 DEVON CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2286
Mailing Address - Country:US
Mailing Address - Phone:209-747-2700
Mailing Address - Fax:
Practice Address - Street 1:2700 DR MARTIN LUTHER KING JR ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5019
Practice Address - Country:US
Practice Address - Phone:317-931-4300
Practice Address - Fax:317-931-4330
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02006458A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program