Provider Demographics
NPI:1750052494
Name:MOSS, BILL R
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:R
Last Name:MOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N STRONG BLVD STE 500A
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-3839
Mailing Address - Country:US
Mailing Address - Phone:918-715-3114
Mailing Address - Fax:918-916-8004
Practice Address - Street 1:1609 N STRONG BLVD STE 500A
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-3839
Practice Address - Country:US
Practice Address - Phone:918-715-3114
Practice Address - Fax:918-916-8004
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
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