Provider Demographics
NPI:1316944820
Name:MOZIA, NELSON (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MOZIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8550 W 38TH AVE
Mailing Address - Street 2:205
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4300
Mailing Address - Country:US
Mailing Address - Phone:303-425-2797
Mailing Address - Fax:303-467-9510
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:205
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4300
Practice Address - Country:US
Practice Address - Phone:303-425-2797
Practice Address - Fax:303-467-9510
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24258208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONO226608OtherANTHEM GROUP
CO4009642OtherAETNA
CO01242585Medicaid
COMO226618OtherANTHEM INDIVIDUAL
CO84091995301OtherPACIFICARE
CO110003193OtherRAILROAD MEDICARE
CO840919953001OtherRMHP
CO800330000OtherTRICARE
CO805651Medicare PIN
CO110003193OtherRAILROAD MEDICARE