Provider Demographics
NPI:1093032435
Name:MOSS, ADAM MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MATTHEW
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3100 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4227
Mailing Address - Country:US
Mailing Address - Phone:952-848-8300
Mailing Address - Fax:952-848-8315
Practice Address - Street 1:3100 W 70TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4227
Practice Address - Country:US
Practice Address - Phone:952-848-8300
Practice Address - Fax:952-848-8315
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY46931207W00000X
OH35123510207W00000X
MN59501207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology