Provider Demographics
NPI:1093834814
Name:MOSHER, WILLIAM BRADFORD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRADFORD
Last Name:MOSHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:BRADFORD
Other - Last Name:MOSHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:45392 DANBURY CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1046
Mailing Address - Country:US
Mailing Address - Phone:734-748-4247
Mailing Address - Fax:734-647-3074
Practice Address - Street 1:207 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1050
Practice Address - Country:US
Practice Address - Phone:734-764-8330
Practice Address - Fax:734-647-3074
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001265363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical