Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 37547 | WI |
N | 2080P0201X | Pediatric Allergist | 37547 | WI |
NPI | 1093781163 |
---|---|
Provider Name | Mark H Moss |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 14/01/2021 |