Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036130220 | IL |
N | 207X00000X | Orthopaedic Surgeon | 20A11514 | CA |
N | 207X00000X | Orthopaedic Surgeon | 5101016864 | MI |
NPI | 1013134394 |
---|---|
Provider Name | Dr. Brian Harris Moss |
First Address | Arlington Heights, IL 60005-3929 |
Second Address | Arlington Heights, IL 60005-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 18/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1615125 | BCBS OF IL (01) | IL |