Provider Demographics
NPI:1114914660
Name:MOSS, GREGORY B (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3489
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-3489
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-386-9605
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-386-9605
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026241207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA440001717OtherRR MEDICARE
WA8127953Medicaid
WA117848OtherL & I
WA8127953Medicaid
E96173Medicare UPIN