Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 10782 | ND |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 10091 | SC |
N | 2080N0001X | Neonatal-Perinatal Doctor | 10782 | ND |
NPI | 1144291014 |
---|---|
Provider Name | Dr. John Edward Moss JR. |
First Address | Florence, SC 29506-2716 |
Second Address | Florence, SC 29506-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D-90738 | (02) | SC |