Provider Demographics
NPI:1649236332
Name:MOSBORG, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MOSBORG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1895 KINGSLEY AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-276-1446
Mailing Address - Fax:904-276-1448
Practice Address - Street 1:1895 KINGSLEY AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-276-1446
Practice Address - Fax:904-276-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0061356207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14755OtherBCBS OF FL
FL219186OtherAVMED
FL2145892002OtherCIGNA
FL4275862OtherAETNA
FLK3741Medicare PIN
FL14755ZMedicare ID - Type Unspecified
F22725Medicare UPIN