Provider Demographics
NPI:1013942317
Name:MOSS, JUDITH A (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:MOSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 PAGONIA RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6008
Mailing Address - Country:US
Mailing Address - Phone:407-905-6006
Mailing Address - Fax:407-636-7806
Practice Address - Street 1:17325 PAGONIA RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6008
Practice Address - Country:US
Practice Address - Phone:407-905-6006
Practice Address - Fax:407-636-7806
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13038207Q00000X
TXJ6020207Q00000X
VA0102203470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130882704Medicaid
VA1013942317Medicaid
TX130882707Medicaid
VA1013942317OtherANTHEM
VA1013942317OtherANTHEM
TXG09803Medicare UPIN
TX130882707Medicaid