Provider Demographics
NPI:1205837150
Name:MOSHER, STEVEN F (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:F
Last Name:MOSHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 1213
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1213
Mailing Address - Country:US
Mailing Address - Phone:912-466-5000
Mailing Address - Fax:912-466-5013
Practice Address - Street 1:2500 STARLING STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4294
Practice Address - Country:US
Practice Address - Phone:912-466-5196
Practice Address - Fax:912-466-5197
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62034207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A620341Medicaid
CAA62034OtherMEDICARE
CA00A620341Medicaid