Provider Demographics
NPI:1457455446
Name:MOSS, STEPHEN VINCENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VINCENT
Last Name:MOSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-3616
Mailing Address - Country:US
Mailing Address - Phone:512-415-9070
Mailing Address - Fax:210-598-7872
Practice Address - Street 1:4006 DEER TRL
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-3616
Practice Address - Country:US
Practice Address - Phone:512-415-9070
Practice Address - Fax:210-598-7872
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U13265Medicare UPIN
00K67HMedicare ID - Type Unspecified