Provider Demographics
NPI:1235241779
Name:MOSER, ROBERT P JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:MOSER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2148
Mailing Address - Country:US
Mailing Address - Phone:785-621-6556
Mailing Address - Fax:857-621-4164
Practice Address - Street 1:3515 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3633
Practice Address - Country:US
Practice Address - Phone:620-603-7398
Practice Address - Fax:620-796-2274
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21464207Q00000X, 207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105239Medicare ID - Type Unspecified
KSD92339Medicare UPIN