Organization
PARKSIDE SURGERY AND MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIAN C MOSLEY JR. M.D. (GENERAL SURGEON/OWNER)
(314) 768-3634
Entity
Organization
Contact information
Practice address
6125 CLAYTON AVE, SUITE 430, SAINT LOUIS, MO 63139-3265
(314) 768-3634
(314) 768-3638
Mailing address
6125 CLAYTON AVE, SUITE 430, SAINT LOUIS, MO 63139-3265
(314) 768-3634
(314) 768-3638
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R5845
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197390
BCBS MO
MO
Enumeration date
10/18/2007
Last updated
10/18/2007
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