# RICHARD MOSS MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154789436
- **Authorized official:** LISA YUCATONIS LPN (OFFICE MANAGER)
- **Authorized official phone:** (812) 634-6666

## Contact information

- **Practice address:** 721 W 13TH ST, SUITE 208, JASPER, IN 47546-1855
- **Practice address phone:** (812) 634-6666
- **Practice address fax:** (812) 634-6669
- **Mailing address:** 721 W 13TH ST, SUITE 208, JASPER, IN 47546-1855
- **Mailing address phone:** (812) 634-6666
- **Mailing address fax:** (812) 634-6669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 01039795A | IN | Yes |

## Other

- **Enumeration date:** 02/02/2016
- **Last updated:** 02/02/2016