Provider Demographics
NPI:1144357690
Name:MOSOLF PEDIATRICS PA
Entity type:Organization
Organization Name:MOSOLF PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOSOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-249-3858
Mailing Address - Street 1:14197 SPARTINA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3225
Mailing Address - Country:US
Mailing Address - Phone:904-249-3858
Mailing Address - Fax:904-592-5324
Practice Address - Street 1:14197 SPARTINA CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-3225
Practice Address - Country:US
Practice Address - Phone:904-249-3858
Practice Address - Fax:904-592-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care