Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 01039795 | IN |
NPI | 1326097619 |
---|---|
Provider Name | Dr. Richard Moss |
First Address | Jasper, IN 47546-1855 |
Second Address | Jasper, IN 47546-1855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100110900A | (05) | IN |
D38243 | (02) | IN |