Individual
DR. ROBERT JAY MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 NORTHWOODS RD, DEERFIELD, IL 60015-2222
(843) 373-8453
Mailing address
1775 BALLARD RD, PARK RIDGE, IL 60068-1005
(847) 318-2500
(847) 318-2558
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
036059412
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059412
—
IL
01
—
L69140
MEDICARE ID
IL
Enumeration date
07/03/2006
Last updated
11/03/2021
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