Provider Demographics
NPI:1851399463
Name:MOSS, JESSE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:MOSS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12602 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3269
Mailing Address - Country:US
Mailing Address - Phone:210-656-8888
Mailing Address - Fax:210-656-2608
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 211
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3269
Practice Address - Country:US
Practice Address - Phone:210-656-8888
Practice Address - Fax:210-656-2608
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH3795207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B88NMedicare ID - Type UnspecifiedMEDICARE
TXE03389Medicare UPIN