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General NPI Number Information
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NPI Number | 1750350880
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Entity Type | Individual
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Provider Name | CHARLES MOSER MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 1600 ST. JOHNS BLVD SUITE 101
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1190
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Country | US
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Telephone | 651-842-5355
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Fax | 651-770-9153
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Provider Business Mailing Address
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Address Line | PO BOX 86 SDS 12 2901
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-2901
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Country | US
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Telephone | 651-968-5050
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Fax | 651-968-5900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 25704
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License Number State | MN
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