Provider Demographics
NPI:1134112139
Name:MOSTELLER, MATTHEW WOOLEY (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WOOLEY
Last Name:MOSTELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-473-1900
Mailing Address - Fax:251-470-8943
Practice Address - Street 1:3701 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1756
Practice Address - Country:US
Practice Address - Phone:251-341-3368
Practice Address - Fax:251-341-3371
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL0009543207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALB65597OtherHEALTHSPRING PROVIDER #
AL4006688OtherAETNA PROVIDER #
AL51034514OtherBLUE CROSS PROVIDER #
AL0810032OtherUNITED HEALTHCARE PROV #
AL4006688OtherAETNA PROVIDER #