Provider Demographics
NPI:1720178718
Name:MOSS, LOIS LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:LYNN
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 1:2105 E NATIONAL AVE
Mailing Address - Street 2:LOIS LYNN MOSS MD
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2830
Mailing Address - Country:US
Mailing Address - Phone:812-443-7605
Mailing Address - Fax:
Practice Address - Street 1:2105 E NATIONAL AVE
Practice Address - Street 2:LOIS LYNN MOSS MD
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2830
Practice Address - Country:US
Practice Address - Phone:812-443-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics