MEDICARE: DR. JAMIE MICHELLE MOENSTER D.O.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	006018	AZ
2	208600000X	Surgery Physician	34.008986	OH

General Provider Information

NPI Number	:	1710189931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE MICHELLE MOENSTER D.O.

Provider Business Mailing Address
First Line	:	698 E WETMORE RD STE 310
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1752
Country	:	US
Telephone Number	:	520-207-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	698 E WETMORE RD STE 310
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1752
Country	:	US
Telephone Number	:	520-207-3100
Fax Number	:	520-777-7634

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/26/2023

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