Provider Demographics
NPI:1770834319
Name:MOSLEY, COLEMAN ALBERT JR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:ALBERT
Last Name:MOSLEY
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 LYNDON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1644
Mailing Address - Country:US
Mailing Address - Phone:619-933-1357
Mailing Address - Fax:
Practice Address - Street 1:1855 LYNDON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1644
Practice Address - Country:US
Practice Address - Phone:619-933-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39237207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology