Provider Demographics
NPI:1730225582
Name:MOSER, JEFFREY D (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:MOSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CITY HALL AVE
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2614
Mailing Address - Country:US
Mailing Address - Phone:978-630-3862
Mailing Address - Fax:
Practice Address - Street 1:57 CITY HALL AVE
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2614
Practice Address - Country:US
Practice Address - Phone:978-630-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2002213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70973OtherBLUE CROSS BLUE SHIELD
MA33456OtherHARVARD PILGRIM
MA002002OtherTUFTS
MA002002OtherTUFTS
Y70973Medicare ID - Type Unspecified