Provider Demographics
NPI:1982672242
Name:MOSHIER, JASON L (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:MOSHIER
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 1:2024 DORCHESTER CT STE 2
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6546
Mailing Address - Country:US
Mailing Address - Phone:574-537-1626
Mailing Address - Fax:574-364-2939
Practice Address - Street 1:2024 DORCHESTER CT STE 2
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6546
Practice Address - Country:US
Practice Address - Phone:574-537-1626
Practice Address - Fax:574-364-2939
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060576A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200518120Medicaid
INI30761Medicare UPIN
INM400015066Medicare PIN
IN318000DMedicare ID - Type Unspecified
IN200518120Medicaid