Provider Demographics
NPI:1558028217
Name:MOSES, GARY LYNN (ND)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LYNN
Last Name:MOSES
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 NARA VISA RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6127
Mailing Address - Country:US
Mailing Address - Phone:505-344-1557
Mailing Address - Fax:
Practice Address - Street 1:355 NARA VISA RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6127
Practice Address - Country:US
Practice Address - Phone:505-344-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No173C00000XOther Service ProvidersReflexologist