Provider Demographics
NPI:1891738829
Name:MOSS, MORRIS D (MD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:D
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:DAVID
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:290 OLD JACKSON HIGHWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9089
Mailing Address - Country:US
Mailing Address - Phone:270-678-5740
Mailing Address - Fax:270-678-4701
Practice Address - Street 1:290 OLD JACKSON HIGHWAY LOOP
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9089
Practice Address - Country:US
Practice Address - Phone:270-678-5740
Practice Address - Fax:270-678-4701
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18657208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18657OtherKENTUCKY
KY18657OtherKENTUCKY