MEDICARE: MS. ANDREA D MOSER PA

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	363A00000X	Physician Assistant	1433	OK

General Provider Information

NPI Number	:	1558332981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA D MOSER PA

Provider Business Mailing Address
First Line	:	6205 N SANTA FE AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7536
Country	:	US
Telephone Number	:	405-231-8740
Fax Number	:	405-231-8714

Provider Business Practice Location Address
First Line	:	6205 N SANTA FE AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118
Country	:	US
Telephone Number	:	405-231-8740
Fax Number	:	405-231-8714

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	02/20/2019

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