Individual
KEVIN MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N DIXIE FWY STE 1, NEW SMYRNA BEACH, FL 32168-6200
(386) 423-0505
(386) 423-0515
Mailing address
1055 N DIXIE FWY STE 1, NEW SMYRNA BEACH, FL 32168-6200
(386) 423-0505
(386) 423-0515
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301063798
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301063798
MEDICAL LICENSE NUMBER
MI
Enumeration date
08/23/2016
Last updated
08/23/2016
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