Provider Demographics
NPI:1770699555
Name:MOSER, BRAD ROBERT (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:ROBERT
Last Name:MOSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:775 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7314
Practice Address - Country:US
Practice Address - Phone:952-944-2519
Practice Address - Fax:952-944-0460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN44775207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP40350OtherHEALTHPARTNERS
328M7MOOtherBLUECROSS BLUESHIELD
969991031808OtherPREFERREDONE
118708OtherMEDICA
HP40350OtherHEALTHPARTNERS