MEDICARE: DR. IRA STEWART MOSKOWITZ 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	207Q00000X	Family Medicine Physician	A32176	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A32176	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1679579163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA STEWART MOSKOWITZ M.D.

Provider Business Mailing Address
First Line	:	278 AVOCADO AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-4604
Country	:	US
Telephone Number	:	619-579-2122
Fax Number	:	619-442-1176

Provider Business Practice Location Address
First Line	:	278 AVOCADO AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-4604
Country	:	US
Telephone Number	:	619-579-2122
Fax Number	:	619-442-1176

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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