Provider Demographics
NPI:1720616709
Name:MOSTER, AUSTIN THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:THOMAS
Last Name:MOSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E BOYD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2832
Mailing Address - Country:US
Mailing Address - Phone:317-462-3441
Mailing Address - Fax:
Practice Address - Street 1:300 E BOYD AVE STE 120
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2832
Practice Address - Country:US
Practice Address - Phone:317-462-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006951A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine