Provider Demographics
NPI:1417108291
Name:MOSBURG, JERAMY DON (DO)
Entity Type:Individual
Prefix:DR
First Name:JERAMY
Middle Name:DON
Last Name:MOSBURG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 MORTON PLANT STREET
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3394
Mailing Address - Country:US
Mailing Address - Phone:727-443-0611
Mailing Address - Fax:727-461-5493
Practice Address - Street 1:430 MORTON PLANT STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3394
Practice Address - Country:US
Practice Address - Phone:727-443-0611
Practice Address - Fax:727-461-5493
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13429207RC0200X, 207RP1001X, 207RP1001X
AZ005155207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ406391Medicaid
AZ406391Medicaid
AZZ130601Medicare PIN