Provider Demographics
NPI:1184685075
Name:MOSS, KENNETH ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-788-8808
Mailing Address - Fax:303-788-6656
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-788-8808
Practice Address - Fax:303-788-6656
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-07-21
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Provider Licenses
StateLicense IDTaxonomies
CO30769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01307693Medicaid
CO29024081Medicaid
COF02997Medicare UPIN
CO01307693Medicaid
CO29024081Medicaid
COC810267Medicare PIN