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1871593129

NPI Code Detail

MEDICARE: JOHN ORMOND MOSMAN M.D.

MEDICARE: JOHN ORMOND MOSMAN M.D.

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	208000000X	Pediatrics Physician	71-65	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21917	OTHER	NM	PRESBYTERIAN HEALTH PLAN
2	NM001961	OTHER	NM	BCBS PROVIDER NUMBER
3	005	OTHER	NM	CIMARRON HEALTH PLAN

General Provider Information

NPI Number	:	1871593129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ORMOND MOSMAN M.D.

Provider Business Mailing Address
First Line	:	8308 CONSTITUTION PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7637
Country	:	US
Telephone Number	:	505-293-1333
Fax Number	:	505-293-4357

Provider Business Practice Location Address
First Line	:	8308 CONSTITUTION PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7637
Country	:	US
Telephone Number	:	505-293-1333
Fax Number	:	505-293-4357

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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Directions to “ JOHN ORMOND MOSMAN M.D.” Practice Location

Language	Start Address	Practice Location

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