Provider Demographics
NPI:1740273481
Name:MOSS, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6230 SCOTT ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3940
Mailing Address - Country:US
Mailing Address - Phone:941-637-5780
Mailing Address - Fax:941-637-5765
Practice Address - Street 1:6230 SCOTT ST
Practice Address - Street 2:SUITE 111
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3940
Practice Address - Country:US
Practice Address - Phone:941-637-5780
Practice Address - Fax:941-637-5765
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2013-02-25
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Provider Licenses
StateLicense IDTaxonomies
FLME84424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4355228OtherAETNA
FL264083000Medicaid
FL15376OtherBCBS
FL2345224005OtherCIGNA
FL040017167Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL15376AMedicare ID - Type Unspecified
FLC25290Medicare UPIN