Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101039736 | KY |
Y | 207PE0004X | Emergency Medical Services | 0101039736 | VA |
NPI | 1144272519 |
---|---|
Provider Name | Fredrick M Moses |
First Address | Wytheville, VA 24382-5666 |
Second Address | Marion, VA 24354-6587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 23/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1144272519 | (05) | VA |
7100148440 | (05) | KY |
B05071 | (02) |