Individual
DR. ERIC M OSSOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4212 N 16TH STREET, PHOENIX INDIAN MEDICAL CENTER, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1619
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AZ #12127
AZ
207Q00000X
Family Medicine Physician
MN#24356
MN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
AZ #12127
AZ
207QG0300X
Geriatric Medicine (Family Medicine) Physician
MN#24356
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
414160
—
AZ
01
—
AZ0713230
BCBS
AZ
Enumeration date
10/04/2006
Last updated
07/26/2011
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