Individual
BRIDGETT R MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11430 N PORT WASHINGTON RD, MEQUON, WI 53092-3414
(262) 518-1900
(262) 518-5052
Mailing address
11430 N PORT WASHINGTON RD, MEQUON, WI 53092-3414
(262) 518-1900
(262) 518-5052
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
50193
WI
207Q00000X
Family Medicine Physician
Primary
50193
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50193
STATE MEDICAL LICENSE
WI
Enumeration date
04/19/2007
Last updated
02/10/2020
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