Provider Demographics
NPI:1447241781
Name:MOSS, KENNETH WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 VETERANS MEMORIAL DRIVE, NEUROLOGY SECTION
Mailing Address - Street 2:CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-721-6105
Mailing Address - Fax:254-743-0132
Practice Address - Street 1:1901 VETERANS MEMORIAL DRIVE, NEUROLOGY SECTION
Practice Address - Street 2:CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-721-6105
Practice Address - Fax:254-743-0132
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-04-03
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Provider Licenses
StateLicense IDTaxonomies
NC00364022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology