Healthcare Provider Details

I. General information

NPI: 1376512517
Provider Name (Legal Business Name): CRAIG PATRICK MOSIER PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109
US

IV. Provider business mailing address

3196 S MARYLAND PKWY STE 101
LAS VEGAS NV
89109
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-8099
  • Fax: 702-731-8292
Mailing address:
  • Phone: 702-731-8099
  • Fax: 702-731-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA952
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: