Provider Demographics
NPI:1457303760
Name:MOSLEY, ANTHONY DARREL (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DARREL
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 W MARYLAND AVE
Mailing Address - Street 2:STE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1705
Mailing Address - Country:US
Mailing Address - Phone:602-246-3300
Mailing Address - Fax:
Practice Address - Street 1:1840 W MARYLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1705
Practice Address - Country:US
Practice Address - Phone:602-246-3300
Practice Address - Fax:602-246-3303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ095489Medicaid
AZH58082Medicare UPIN
AZ095489Medicaid