MEDICARE: DR. PHILIP MOSCA MD

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	174400000X	Specialist	11232	OK

General Provider Information

NPI Number	:	1598768715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP MOSCA MD

Provider Business Mailing Address
First Line	:	4200 S DOUGLAS AVE
Second Line	:	STE 300
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S DOUGLAS AVE
Second Line	:	STE 300
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3215
Country	:	US
Telephone Number	:	405-634-7727
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/26/2011

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