Healthcare Provider Details

I. General information

NPI: 1669552212
Provider Name (Legal Business Name): SCOTT MOSSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 1010
SAN FRANCISCO CA
94108-3912
US

IV. Provider business mailing address

450 SUTTER ST RM 1010
SAN FRANCISCO CA
94108-3912
US

V. Phone/Fax

Practice location:
  • Phone: 415-780-1515
  • Fax: 628-867-6510
Mailing address:
  • Phone: 415-780-1515
  • Fax: 628-867-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA82437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: