Provider Demographics
NPI:1114540812
Name:MOSU, RICHARD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:MOSU
Suffix:
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 1:850 PETER BRYCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7457
Mailing Address - Country:US
Mailing Address - Phone:205-348-1770
Mailing Address - Fax:205-348-1772
Practice Address - Street 1:850 PETER BRYCE BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7457
Practice Address - Country:US
Practice Address - Phone:205-348-1770
Practice Address - Fax:205-348-1772
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALSTUDENTOtherSTUDENT