Provider Demographics
NPI:1427059963
Name:MOSIER, R. WAYNE (DO)
Entity type:Individual
Prefix:
First Name:R.
Middle Name:WAYNE
Last Name:MOSIER
Suffix:
Gender:M
Credentials:DO
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 1215
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-1215
Mailing Address - Country:US
Mailing Address - Phone:918-567-5490
Mailing Address - Fax:918-567-3564
Practice Address - Street 1:HWY 63 EAST
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-1215
Practice Address - Country:US
Practice Address - Phone:918-567-5490
Practice Address - Fax:918-567-3564
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F42888Medicare UPIN