Provider Demographics
NPI:1962486829
Name:MOSS, CHARLES JOSEPH III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:MOSS
Suffix:III
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:2 S CASCADE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-866-6568
Mailing Address - Fax:719-538-2999
Practice Address - Street 1:715 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1091
Practice Address - Country:US
Practice Address - Phone:719-473-6115
Practice Address - Fax:719-472-2577
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL21451367500000X
AZCRNA0841367500000X
COAPN.0992028-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07107485Medicaid
CO07107485Medicaid