Provider Demographics
NPI:1952583031
Name:JEFF MOSER INC
Entity Type:Organization
Organization Name:JEFF MOSER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:LO, CPED
Authorized Official - Phone:352-527-8200
Mailing Address - Street 1:3778 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9214
Mailing Address - Country:US
Mailing Address - Phone:352-527-8200
Mailing Address - Fax:352-527-8183
Practice Address - Street 1:3778 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9214
Practice Address - Country:US
Practice Address - Phone:352-527-8200
Practice Address - Fax:352-527-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT60222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5352020001Medicare NSC