MEDICARE: DR. DAVID ANTHONY MOSIG D.O.

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	207P00000X	Emergency Medicine Physician	H2623	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A67432	OTHER	TX	UPIN

General Provider Information

NPI Number	:	1548439979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ANTHONY MOSIG D.O.

Provider Business Mailing Address
First Line	:	726 TOM HOLLAND RD
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75901-0711
Country	:	US
Telephone Number	:	936-635-9141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 DICKERSON DR
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-5110
Country	:	US
Telephone Number	:	409-383-2337
Fax Number	:

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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