Provider Demographics
NPI:1326391848
Name:JAMIE M MOENSTER DO PC
Entity Type:Organization
Organization Name:JAMIE M MOENSTER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MOENSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-541-1584
Mailing Address - Street 1:150 S CORONADO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6352
Mailing Address - Country:US
Mailing Address - Phone:520-458-1787
Mailing Address - Fax:520-458-1519
Practice Address - Street 1:150 S CORONADO DR STE 110
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6352
Practice Address - Country:US
Practice Address - Phone:520-458-1787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0060182086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty