Provider Demographics
NPI:1639128317
Name:MOSS, MARK H (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
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 1:3692 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3137
Mailing Address - Country:US
Mailing Address - Phone:713-946-1500
Mailing Address - Fax:713-946-0200
Practice Address - Street 1:8633 BROADWAY ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8497
Practice Address - Country:US
Practice Address - Phone:281-485-2988
Practice Address - Fax:281-485-2337
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1645213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177268301Medicaid
TX8F1880Medicare PIN
TXU96367Medicare UPIN
TX177268301Medicaid