Individual
DR. LUCIEN KENNEDY MOSS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2770 3RD AVE, SUITE 120, LAKE CHARLES, LA 70601
(337) 494-4868
(337) 494-4870
Mailing address
2770 3RD AVE, SUITE 120, LAKE CHARLES, LA 70601-8994
(337) 494-4868
(337) 494-4870
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
015821
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1341280
—
LA
01
—
50046C963
MEDICARE LEGACY
LA
Enumeration date
08/30/2006
Last updated
04/08/2008
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