Provider Demographics
NPI:1962436154
Name:MOSIER, MARJORIE A (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:A
Last Name:MOSIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50820
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0820
Mailing Address - Country:US
Mailing Address - Phone:949-753-0100
Mailing Address - Fax:949-727-3793
Practice Address - Street 1:16300 SAND CANYON AVE STE 1009
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3710
Practice Address - Country:US
Practice Address - Phone:949-753-0100
Practice Address - Fax:949-727-3793
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165328207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23855Medicare UPIN
CAA24221AMedicare ID - Type Unspecified