Provider Demographics
NPI:1457424764
Name:MOSS, JOHN SIMPSON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SIMPSON
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:171 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6460
Practice Address - Country:US
Practice Address - Phone:252-537-5639
Practice Address - Fax:252-537-7198
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200700158207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910110Medicaid
VA010091209Medicaid
NCNCK260AMedicare PIN
VA010091209Medicaid
VA3562925OtherAETNA
NC5910110Medicaid
VA010091209Medicaid