Provider Demographics
NPI:1912920505
Name:MOSES, LYNDA P (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:P
Last Name:MOSES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BAY AREA BLVD APT 912
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1119
Mailing Address - Country:US
Mailing Address - Phone:262-960-1473
Mailing Address - Fax:
Practice Address - Street 1:107 WOODLAWN DR STE 101
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3987
Practice Address - Country:US
Practice Address - Phone:832-783-1079
Practice Address - Fax:281-993-1200
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32598000Medicaid