Provider Demographics
NPI:1154393668
Name:MOESINGER, SCOTT G (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:MOESINGER
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 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-284-3400
Mailing Address - Fax:843-284-3401
Practice Address - Street 1:1380 E MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-2205
Practice Address - Fax:435-251-2202
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1647231205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87037640000106328Medicaid
UT$$$$$$$$$020Medicaid
UT005774701Medicare PIN
D87688Medicare UPIN
UT$$$$$$$$$020Medicaid
UT220008553Medicare PIN