Provider Demographics
NPI:1851608129
Name:MOSKOS, CAMERON HAY (PA-C)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:HAY
Last Name:MOSKOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17809 N 57TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6458
Mailing Address - Country:US
Mailing Address - Phone:480-652-3320
Mailing Address - Fax:
Practice Address - Street 1:4838 E BASELINE RD
Practice Address - Street 2:#103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4671
Practice Address - Country:US
Practice Address - Phone:480-926-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4699363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1094802OtherNCCPA
AZ554244Medicaid
AZMH2232508OtherDEA