Provider Demographics
NPI:1013018597
Name:MOSS, SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LANDONS WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4389
Mailing Address - Country:US
Mailing Address - Phone:972-768-1778
Mailing Address - Fax:512-863-2376
Practice Address - Street 1:2423 WILLIAMS DR
Practice Address - Street 2:SUITE 108
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3200
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-869-8370
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXHO6622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H81BOtherBCBS
TX75-248488875115OtherCHAMPUS
TX114987403Medicaid
TXE12503Medicare UPIN
TXE12503Medicare UPIN