Individual
KIRK TRACY MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14TH MDG, 201 INDEPENDENCE DR, COLUMBUS AFB, MS 39710
(662) 434-2273
Mailing address
14TH MDG, 201 INDEPENDENCE DRIVE, BLDG 1100, COLUMBUS AFB, MS 39710, FPO, AA 93246
66243439710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2838
AK
207Q00000X
Family Medicine Physician
31364
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A0348
BLUE CROSS SUB
—
05
—
MD2838
—
AK
Enumeration date
03/09/2006
Last updated
10/21/2016
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