Individual
FREDRICK M MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
565 RADIO HILL RD, MARION, VA 24354-6587
(276) 782-1234
Mailing address
469 BLUE SKY DR, WYTHEVILLE, VA 24382-5666
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101039736
KY
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
0101039736
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144272519
—
VA
05
—
7100148440
—
KY
Enumeration date
05/16/2006
Last updated
03/23/2011
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