Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0101238143 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | D0021954 | MD |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD0000049564 | TN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD8257 | DC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME94903 | FL |
N | 208200000X | Surgeon | 0101238143 | VA |
N | 208600000X | Surgeon | 0101238143 | VA |
N | 208200000X | Surgeon | D0021954 | MD |
N | 208600000X | Surgeon | D0021954 | MD |
Y | 208200000X | Surgeon | MD0000049564 | TN |
Y | 208600000X | Surgeon | MD0000049564 | TN |
N | 208200000X | Surgeon | MD8257 | DC |
N | 208600000X | Surgeon | MD8257 | DC |
N | 208200000X | Surgeon | ME94903 | FL |
N | 208600000X | Surgeon | ME94903 | FL |
N | 208D00000X | General Practice Physician | 0101238143 | VA |
N | 208D00000X | General Practice Physician | D0021954 | MD |
N | 208D00000X | General Practice Physician | MD0000049564 | TN |
N | 208D00000X | General Practice Physician | MD8257 | DC |
N | 208D00000X | General Practice Physician | ME94903 | FL |
NPI | 1265474159 |
---|---|
Provider Name | Dr. Edward L Mosley |
First Address | Jasper, TN 37347-3695 |
Second Address | Jasper, TN 37347-3695 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 19/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0495776 | AETNA HEALTH MGMNT, LLC (01) | |
112505 | AARP (01) | |
2754 | BLUE CROSS BLUE SHIELD (01) | DC |
6199 | BLUE CROSS BLUE SHIELD (01) | MD |
8257207750000 | TRICARE (01) | |
C87750 | (02) |