Provider Demographics
NPI:1245212224
Name:MOSHER, LAURA GRUEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GRUEN
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GRUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6633 FOREST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:727-724-8611
Mailing Address - Fax:727-724-0425
Practice Address - Street 1:4240 SUN N LAKE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1944
Practice Address - Country:US
Practice Address - Phone:863-471-3926
Practice Address - Fax:863-385-3093
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010012190207RC0000X, 207RI0011X
IL036125967207RC0000X
IL036-125967207RI0011X
FLME125464207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIM594WMedicare PIN
I36474Medicare UPIN
NC2043168Medicare ID - Type Unspecified
FLIM594XMedicare PIN
FLP01680653Medicare PIN