=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588045116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLAN DAVID MOSER DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2015
-----------------------------------------------------
Last Update Date | 06/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2845 W ANDREW JOHNSON HWY
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-585-0050
-----------------------------------------------------
Fax | 423-289-1604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2845 W ANDREW JOHNSON HWY
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-585-0050
-----------------------------------------------------
Fax | 423-289-1604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 012648
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO3433
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------