Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10418 | SD |
NPI | 1003234097 |
---|---|
Provider Name | Drew Moss |
First Address | Spearfish, SD 57783-8809 |
Second Address | Spearfish, SD 57783-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 17/03/2018 |