Provider Demographics
NPI:1083634844
Name:DAVID P MOSCH DO PA
Entity Type:Organization
Organization Name:DAVID P MOSCH DO PA
Other - Org Name:OVIEDO FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-359-7997
Mailing Address - Street 1:100 ALEXANDRIA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8298
Mailing Address - Country:US
Mailing Address - Phone:407-359-7997
Mailing Address - Fax:407-359-6662
Practice Address - Street 1:100 ALEXANDRIA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8298
Practice Address - Country:US
Practice Address - Phone:407-359-7997
Practice Address - Fax:407-359-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110051610OtherMEDICARE RAILROAD
FL110051610OtherMEDICARE RAILROAD