Individual
JONATHAN RANDALL MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
724 AUBREY BELL DR, MATTHEWS, NC 28105-5055
(704) 295-3550
(704) 295-3556
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2010-00143
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000306335
UNISON HEALTH PLAN OF SC
SC
01
—
15857
BCBSNC
NC
01
—
30083055
SELECT HEALTH OF SC
SC
01
—
4678040
CIGNA HEALTHCARE
NC
05
—
5914807
—
NC
01
—
9733523
AETNA
NC
05
—
NC1193
—
SC
01
—
P00866360
RAILROAD MEDICARE
NC
Enumeration date
01/04/2007
Last updated
05/07/2018
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