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1568432607

NPI Code Detail

MEDICARE: DR. SCOTT EDWARD MOSEMAN MD

MEDICARE: DR. SCOTT EDWARD MOSEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	23890	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7012648	OTHER		AETNA BEHAVIORAL HEALTH
3	2089418	OTHER		CIGNA BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1568432607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT EDWARD MOSEMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 21228
Second Line	:	DEPARTMENT 31
City	:	TULSA
State	:	OK
Zip	:	74121-1228
Country	:	US
Telephone Number	:	918-491-3995
Fax Number	:	918-491-5740

Provider Business Practice Location Address
First Line	:	6655 S YALE AVE
Second Line	:	LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
City	:	TULSA
State	:	OK
Zip	:	74136-3326
Country	:	US
Telephone Number	:	918-491-3995
Fax Number	:	918-491-5740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	01/31/2017

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Directions to “ DR. SCOTT EDWARD MOSEMAN MD” Practice Location

Language	Start Address	Practice Location

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