Provider Demographics
NPI:1881622967
Name:ROBERT L. MOESINGER, MD, A PROFESSIONAL CORP
Entity type:Organization
Organization Name:ROBERT L. MOESINGER, MD, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LIONEL
Authorized Official - Last Name:MOESINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-393-5324
Mailing Address - Street 1:3955 HARRISON BLVD STE U6
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2399
Mailing Address - Country:US
Mailing Address - Phone:801-393-5324
Mailing Address - Fax:801-393-7780
Practice Address - Street 1:3955 HARRISON BLVD STE U6
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2399
Practice Address - Country:US
Practice Address - Phone:801-393-5324
Practice Address - Fax:801-393-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151175-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528505626001Medicaid
UT528505626001Medicaid