Provider Demographics
NPI:1326031055
Name:MOSELEY, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MOSELEY
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 1:2732N ALVERNON WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1804
Mailing Address - Country:US
Mailing Address - Phone:520-382-3349
Mailing Address - Fax:520-618-0250
Practice Address - Street 1:2732 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1804
Practice Address - Country:US
Practice Address - Phone:520-382-3330
Practice Address - Fax:520-382-3340
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37344Medicare UPIN
AZ23917Medicare ID - Type Unspecified