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General NPI Number Information
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NPI Number | 1104357284
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Entity Type | Organization
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Legal Business Name | MOSELEY FOOT AND ANKLE CLINIC PLLC
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 2416 MARTIN LUTHER KING JR BLVD
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City | DALLAS
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State | TX
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Zip | 75215-2303
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Country | US
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Telephone | 214-208-9697
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Fax |
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Provider Business Mailing Address
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Address Line | 2416 MARTIN LUTHER KING JR BLVD
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City | DALLAS
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State | TX
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Zip | 75215-2303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. TAMARA ANNELL MOSELEY
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Credential | DPM
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Telephone | 214-208-9697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2057
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License Number State | TX
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