Provider Demographics
NPI:1578726352
Name:MOSS, CLINT CAMERON (MD)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:CAMERON
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:815 PECAN GROVE RD E
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1768
Mailing Address - Country:US
Mailing Address - Phone:903-892-2126
Mailing Address - Fax:903-892-2129
Practice Address - Street 1:815 PECAN GROVE RD E
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1768
Practice Address - Country:US
Practice Address - Phone:903-892-2126
Practice Address - Fax:903-992-2129
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0769207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316328901Medicaid
TXTXB151050Medicare PIN