MEDICARE: MICHAEL T MOSHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	A62252	CA

General Provider Information

NPI Number	:	1053417865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T MOSHER M.D.

Provider Business Mailing Address
First Line	:	415 ROLLING OAKS DR
Second Line	:	SUITE 280
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-1029
Country	:	US
Telephone Number	:	805-496-8522
Fax Number	:	805-496-0469

Provider Business Practice Location Address
First Line	:	415 ROLLING OAKS DR
Second Line	:	SUITE 280
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-1029
Country	:	US
Telephone Number	:	805-496-8522
Fax Number	:	805-496-0469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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