Organization
RICHARD MOSS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA YUCATONIS LPN (OFFICE MANAGER)
(812) 634-6666
Entity
Organization
Contact information
Practice address
721 W 13TH ST, SUITE 208, JASPER, IN 47546-1855
(812) 634-6666
(812) 634-6669
Mailing address
721 W 13TH ST, SUITE 208, JASPER, IN 47546-1855
(812) 634-6666
(812) 634-6669
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
01039795A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207Y00000X
—
IN
Enumeration date
02/02/2016
Last updated
02/02/2016
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