Provider Demographics
NPI:1689630659
Name:MUZQUIZ, MOSES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:
Last Name:MUZQUIZ
Suffix:JR
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 1:1041 LAURENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-787-4111
Mailing Address - Fax:517-782-8869
Practice Address - Street 1:1041 LAURENCE AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-787-4111
Practice Address - Fax:517-782-8869
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301026718207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1979265Medicaid
060010955OtherRR MEDICARE
MI104453837Medicaid
MI060037111OtherRR MEDICARE
060010955OtherRR MEDICARE
MIN53130021Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL