Healthcare Provider Details

I. General information

NPI: 1801950126
Provider Name (Legal Business Name): CHARLES B MOSHER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HWY 49 N
MARIPOSA CA
95338-0155
US

IV. Provider business mailing address

PO BOX 155
MARIPOSA CA
95338-0155
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-3672
  • Fax: 209-966-5548
Mailing address:
  • Phone: 209-966-3672
  • Fax: 209-966-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG20790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: