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General NPI Number Information
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NPI Number | 1326391848
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Entity Type | Organization
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Legal Business Name | JAMIE M MOENSTER DO PC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 150 S CORONADO DR STE 110
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-6352
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Country | US
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Telephone | 520-458-1787
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Fax |
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Provider Business Mailing Address
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Address Line | 150 S CORONADO DR STE 110
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-6352
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Country | US
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Telephone | 520-458-1787
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Fax | 520-458-1519
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Authorized Official
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Title or Position | PRIMARY SHAREHOLDER
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Name | DR. JAMIE MICHELLE MOENSTER
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Credential | D.O.
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Telephone | 636-541-1584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 006018
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License Number State | AZ
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