Individual
DR. EDWARD SIDNEY MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1167 E BROAD ST, MONTICELLO, MS 39654-7682
(601) 587-1433
(601) 587-1625
Mailing address
PO BOX 490, MCCOMB, MS 39649-0490
(601) 250-4366
(601) 250-4367
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
09304
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010333
—
MS
01
—
060039545
RAILROAD MEDICARE
MS
01
—
MS09304
UPIN BLUE CROSS
MS
Enumeration date
08/24/2006
Last updated
06/30/2023
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