Healthcare Provider Details

I. General information

NPI: 1639557093
Provider Name (Legal Business Name): ALEX MOSELEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MACK RD STE 100
FAIRFIELD OH
45014-5335
US

IV. Provider business mailing address

3000 MACK RD STE 100
FAIRFIELD OH
45014-5335
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-4222
  • Fax: 513-874-3023
Mailing address:
  • Phone: 513-751-4222
  • Fax: 513-874-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125066313
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.133528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: