MEDICARE: MR. STEPHEN JACOB MOSLEY PA-C

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	363AM0700X	Medical Physician Assistant	1264	SC
2	363A00000X	Physician Assistant	PA9109639	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407182421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN JACOB MOSLEY PA-C

Provider Business Mailing Address
First Line	:	64 PINE KNOLL LN
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-4588
Country	:	US
Telephone Number	:	770-757-2190
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 PINE KNOLL LN
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-4588
Country	:	US
Telephone Number	:	770-757-2190
Fax Number	:

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

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	03/19/2026

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