Provider Demographics
NPI:1588630404
Name:MOSER, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:MOSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6615 CLINGAN ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4202
Mailing Address - Country:US
Mailing Address - Phone:330-707-1425
Mailing Address - Fax:330-757-2814
Practice Address - Street 1:6615 CLINGAN ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4202
Practice Address - Country:US
Practice Address - Phone:330-707-1425
Practice Address - Fax:330-757-2814
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-086492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFO9371331OtherPTAN
OH35-086492OtherLICENSE
OH35-086492OtherLICENSE
I38890Medicare UPIN
OHMO4167082Medicare PIN