Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1952471625 |
---|---|
Provider Name | Mr. Jordan Harrison Moss SR. |
First Address | Birmingham, AL 35223-1647 |
Second Address | Birmingham, AL 35242-3785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |