Provider Demographics
NPI:1265469829
Name:MOSS, JOSEPH FRANKLIN (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANKLIN
Last Name:MOSS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-594-2450
Mailing Address - Fax:903-509-0493
Practice Address - Street 1:1801 N DICKINSON DR
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1264
Practice Address - Country:US
Practice Address - Phone:903-683-3600
Practice Address - Fax:903-683-3692
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183065501Medicaid
970018502OtherMEDICARE RR
P28528Medicare UPIN
TX8L1593Medicare PIN
970018502Medicare PIN
TX183065501Medicaid