Provider Demographics
NPI:1154396513
Name:MOSSOP, PATRICIA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:MOSSOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:KIESOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12703 SHADOW RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6446
Mailing Address - Country:US
Mailing Address - Phone:813-677-3822
Mailing Address - Fax:813-910-4037
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:JAMES A HALEY VAMC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-910-4037
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine