Provider Demographics
NPI:1700846656
Name:MOSES, TIMOTHY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 REDSTONE AVE W STE 370
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6429
Mailing Address - Country:US
Mailing Address - Phone:850-423-9976
Mailing Address - Fax:850-306-3767
Practice Address - Street 1:550 REDSTONE AVE W STE 370
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6429
Practice Address - Country:US
Practice Address - Phone:850-423-9976
Practice Address - Fax:850-306-3767
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500670208800000X
SC17208208800000X
FLME144367208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790110WMedicaid
NC340013661OtherRAILROAD MEDICARE
NC8960187Medicaid
NC0110WOtherBLUE CROSS BLUE SHIELD
NC340013661OtherRAILROAD MEDICARE
NC8960187Medicaid