Individual
JASON FONDREN MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4 MEDICAL BLVD, HATTIESBURG, MS 39401
(601) 579-5444
(601) 579-3083
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5444
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
04083
KY
207RI0200X
Infectious Disease Physician
Primary
26163
MS
Other
Enumeration date
04/08/2014
Last updated
03/01/2019
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