Provider Demographics
NPI:1689673600
Name:MOSS, NORMAN WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:WILLIAM
Last Name:MOSS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8051
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-0051
Mailing Address - Country:US
Mailing Address - Phone:509-248-6192
Mailing Address - Fax:509-452-5433
Practice Address - Street 1:215 S 11TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3255
Practice Address - Country:US
Practice Address - Phone:509-248-6192
Practice Address - Fax:509-452-5433
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00008347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA10619OtherLABOR & INDUSTRIES
WA7107857Medicaid
WAA06583Medicare UPIN
WA7107857Medicaid