Provider Demographics
NPI:1033790126
Name:MOSLEY, ETHAN H (DO)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:H
Last Name:MOSLEY
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Gender:M
Credentials:DO
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Mailing Address - Street 1:GRAND STRAND MEDICAL CENTER- GME OFFICE
Mailing Address - Street 2:809 82ND PKWY
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-692-1595
Mailing Address - Fax:843-692-1122
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-1227
Practice Address - Fax:843-692-1122
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2025-09-02
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Provider Licenses
StateLicense IDTaxonomies
KS05-51642207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology