Healthcare Provider Details

I. General information

NPI: 1043366735
Provider Name (Legal Business Name): KEITH ALDEN MOSHER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 S 1ST ST
MILAN TN
38358-5132
US

IV. Provider business mailing address

15001 S 1ST ST
MILAN TN
38358-5132
US

V. Phone/Fax

Practice location:
  • Phone: 731-613-2535
  • Fax: 731-613-2534
Mailing address:
  • Phone: 731-613-2535
  • Fax: 731-613-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24751
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24751
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: