=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518090125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES C MOSLEY III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 04/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 789 S MOUNT AUBURN RD
-----------------------------------------------------
City | CAPE GIRARDEAU
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63703-6387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-519-4830
-----------------------------------------------------
Fax | 573-519-4870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 789 S MOUNT AUBURN RD
-----------------------------------------------------
City | CAPE GIRARDEAU
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63703-6387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-519-4830
-----------------------------------------------------
Fax | 573-519-4870
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 2006008795
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------