Individual
JERRY D MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7705
Mailing address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7705
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6802073537
MI
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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