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Individual

MR. GARY BLAIR MOSS

Active
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Individual

MR. GARY BLAIR MOSS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101049940
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326022880
GROUP NPI#
—
01
—
1588665137
INDIVIDUAL NPI#
—
01
—
322700
ANTHEM
VA
01
—
348140
MAMSI
VA
01
—
56572
OPTIMA/SENTARA
VA
05
—
5803071
—
VA
01
—
C01592
MEDICARE GROUP #
VA
01
—
CF1969
RAILROAD MEDICARE GROUP #
—
Enumeration date
08/04/2005
Last updated
08/02/2016
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