Individual
DR. MARK E MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3215 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4424
(479) 463-7102
(479) 463-7864
Mailing address
PO BOX 550, LOWELL, AR 72745-0550
(479) 463-7775
(479) 463-7187
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
E-3803
AR
2085R0204X
Vascular & Interventional Radiology Physician
Primary
E-3803
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158197001
—
AR
05
—
20083990A
—
OK
Enumeration date
05/04/2006
Last updated
06/21/2019
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