Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | K0140 | TX |
NPI | 1003193293 |
---|---|
Provider Name | Tracy H. Moss |
First Address | Brownsville, TX 78521 |
Second Address | Brownsville, TX 78521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 26/04/2021 |