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Individual
DR. MARK JEFFREY MOSS
Active
Individual
DR. MARK JEFFREY MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901000715
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1352311
—
MI
01
—
382334116
TAX ID
—
01
—
480045246
RAILROAD MEDICARE
MI
01
—
4858254620
BLUE CROSS
MI
Enumeration date
07/28/2006
Last updated
11/21/2013
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