Provider Demographics
NPI:1396852943
Name:FENBERG, MOSS JACOB (MD)
Entity Type:Individual
Prefix:
First Name:MOSS
Middle Name:JACOB
Last Name:FENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:270 E 8TH AVE
Mailing Address - Street 2:STE N-101
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5708
Mailing Address - Country:US
Mailing Address - Phone:970-828-2200
Mailing Address - Fax:970-828-2201
Practice Address - Street 1:270 E 8TH AVE
Practice Address - Street 2:STE N-101
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5708
Practice Address - Country:US
Practice Address - Phone:970-828-2200
Practice Address - Fax:970-828-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50343207W00000X
NMMD2012-0618207W00000X, 207WX0107X
CO0050343207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology