Provider Demographics
NPI:1801080262
Name:L.R. MOSES, DO, ASSOCIATION
Entity type:Organization
Organization Name:L.R. MOSES, DO, ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUFKIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-235-3800
Mailing Address - Street 1:301 JENNY GEORGE LN
Mailing Address - Street 2:STE 6
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7152
Mailing Address - Country:US
Mailing Address - Phone:325-235-3800
Mailing Address - Fax:325-235-3313
Practice Address - Street 1:301 JENNY GEORGE LN
Practice Address - Street 2:STE 6
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7152
Practice Address - Country:US
Practice Address - Phone:325-235-3800
Practice Address - Fax:325-235-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6855208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139498301Medicaid
TX0049JLOtherBCBS
TX0A5848Medicare PIN
TX139498301Medicaid