Provider Demographics
NPI:1588626493
Name:MOSS, STEPHEN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:MOSS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-347-8872
Mailing Address - Fax:727-343-6670
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-347-8872
Practice Address - Fax:727-343-6670
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO573213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0742550001Medicare NSC
FLT55385Medicare UPIN