Provider Demographics
NPI:1548340839
Name:MOUSSA, FRANK W (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:W
Last Name:MOUSSA
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 1:4614 E SHEA BLVD
Mailing Address - Street 2:SUITE D-160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3070
Mailing Address - Country:US
Mailing Address - Phone:602-569-9907
Mailing Address - Fax:
Practice Address - Street 1:4614 E SHEA BLVD
Practice Address - Street 2:SUITE D-160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3070
Practice Address - Country:US
Practice Address - Phone:602-569-9907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28192207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0869320OtherBCBS
AZ7351020OtherAETNA
AZ52738501Medicaid
C49270Medicare UPIN
AZ52738501Medicaid
AZAZ0869320OtherBCBS