1154396513 NPI number — DR. PATRICIA ANNE MOSSOP MD

Table of content: DR. PATRICIA ANNE MOSSOP MD (NPI 1154396513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154396513 NPI number — DR. PATRICIA ANNE MOSSOP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSSOP
Provider First Name:
PATRICIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIESOW
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154396513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12703 SHADOW RUN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33569-6446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-677-3822
Provider Business Mailing Address Fax Number:
813-910-4037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
JAMES A HALEY VAMC
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-972-2000
Provider Business Practice Location Address Fax Number:
813-910-4037
Provider Enumeration Date:
02/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME0052111 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)