Provider Demographics
NPI:1851315279
Name:MOSER, JEFFERY GRAY (LO, CPED)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:GRAY
Last Name:MOSER
Suffix:
Gender:M
Credentials:LO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3778 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9214
Mailing Address - Country:US
Mailing Address - Phone:352-527-8200
Mailing Address - Fax:352-527-8183
Practice Address - Street 1:3778 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9214
Practice Address - Country:US
Practice Address - Phone:352-527-8200
Practice Address - Fax:352-527-8183
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT60222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M2737OtherBLUE CROSS BLUE SHIELD
M2737OtherBLUE CROSS BLUE SHIELD