Provider Demographics
NPI:1366483687
Name:MOSCH, DAVID PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:MOSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 ALEXANDRIA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8298
Mailing Address - Country:US
Mailing Address - Phone:407-359-7997
Mailing Address - Fax:407-359-6662
Practice Address - Street 1:100 ALEXANDRIA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8298
Practice Address - Country:US
Practice Address - Phone:407-359-7997
Practice Address - Fax:407-359-6662
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110051610OtherMEDICARE RAILROAD
FL80280OtherBCBS
FLCIGNAOther550208
FL3499OtherHUMANA
FL206323OtherAVMED
FLCIGNAOther550208
FL80280VMedicare ID - Type Unspecified