Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD60380187 | WA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD60380187 | WA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 38958 | IA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD60380187 | WA |
NPI | 1508020314 |
---|---|
Provider Name | Michael J Mosley |
First Address | Puyallup, WA 98372-3770 |
Second Address | Puyallup, WA 98372-3770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 30/08/2013 |