Provider Demographics
NPI:1093100323
Name:JOHN A MOSS MD
Entity Type:Organization
Organization Name:JOHN A MOSS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-637-5780
Mailing Address - Street 1:6230 SCOTT ST
Mailing Address - Street 2:111
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3939
Mailing Address - Country:US
Mailing Address - Phone:941-637-5780
Mailing Address - Fax:941-627-5765
Practice Address - Street 1:6230 SCOTT ST
Practice Address - Street 2:111
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3939
Practice Address - Country:US
Practice Address - Phone:941-637-5780
Practice Address - Fax:941-627-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty