Healthcare Provider Details

I. General information

NPI: 1295466837
Provider Name (Legal Business Name): JACOB MOSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 CYPRESS CREEK RD STE 104
CEDAR PARK TX
78613-4484
US

IV. Provider business mailing address

6034 W COURTYARD DR STE 110
AUSTIN TX
78730-5064
US

V. Phone/Fax

Practice location:
  • Phone: 512-336-2778
  • Fax:
Mailing address:
  • Phone: 512-328-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW0239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: