Provider Demographics
NPI:1821106592
Name:MOSLEY, JERRY V (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:V
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1202 SHADES CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-9132
Mailing Address - Country:US
Mailing Address - Phone:205-221-1516
Mailing Address - Fax:205-387-9539
Practice Address - Street 1:701 19TH ST E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5503
Practice Address - Country:US
Practice Address - Phone:205-221-1516
Practice Address - Fax:205-384-9539
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL9000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC-73792Medicare UPIN
AL000083122Medicare ID - Type Unspecified