Provider Demographics
NPI:1205096260
Name:MOSIER, SUSAN M (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MOSIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-7748
Mailing Address - Country:US
Mailing Address - Phone:740-707-4271
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-3065
Practice Address - Fax:253-968-0384
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010876208000000X
NE575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics