Provider Demographics
NPI:1679522742
Name:MOSKOW, JOHN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRUCE
Last Name:MOSKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 PLUMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 W 34TH ST
Practice Address - Street 2:#101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1240
Practice Address - Country:US
Practice Address - Phone:512-452-8533
Practice Address - Fax:512-452-6685
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4309207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8404K2Medicare PIN
TX8B9190Medicare PIN
TX8F6598Medicare PIN
TX8F1927Medicare PIN
TX8F2763Medicare PIN
TX8B9866Medicare PIN
TX8F0105Medicare PIN
TX8F2732Medicare PIN
TX8F2766Medicare PIN
TXC19660Medicare UPIN
TX85K115Medicare PIN
TX87420NMedicare PIN