Individual
DR. SUE MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2423 WILLIAMS DR, SUITE 108, GEORGETOWN, TX 78628-3200
(877) 800-5722
(512) 869-8370
Mailing address
136 LANDONS WAY, GEORGETOWN, TX 78633-4389
(972) 768-1778
(512) 863-2376
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
HO662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00H81B
BCBS
TX
05
—
114987403
—
TX
01
—
75-248488875115
CHAMPUS
TX
Enumeration date
09/26/2006
Last updated
03/23/2015
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