Provider Demographics
NPI:1356373617
Name:MOZEN, EDDIE SPERLING (MD)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:SPERLING
Last Name:MOZEN
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:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-0805
Mailing Address - Country:US
Mailing Address - Phone:530-271-1791
Mailing Address - Fax:530-270-2090
Practice Address - Street 1:10121 PINE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96160
Practice Address - Country:US
Practice Address - Phone:530-582-3200
Practice Address - Fax:530-587-6123
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89923207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G507300Medicaid
A89923Medicare UPIN
CA00G507300Medicaid