Provider Demographics
NPI:1790060754
Name:MOSESON, JORDAN SETH (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:SETH
Last Name:MOSESON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9054 MORISET CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8903 GLADES RD STE K1A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4010
Practice Address - Country:US
Practice Address - Phone:561-395-2626
Practice Address - Fax:561-955-6121
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13426208600000X, 208C00000X, 208600000X
PAOS016532208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty