Individual
LEWIS M MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
364 OCEAN AVE, LAGUNA BEACH, CA 92651
(949) 557-0610
Mailing address
364 OCEAN AVE, LAGUNA BEACH, CA 92651-2322
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C32298
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C322980
BLUE SHIELD
CA
05
—
00C322980
—
CA
01
—
C32298
ANTHEM BLUE CROSS
CA
Enumeration date
06/29/2006
Last updated
09/24/2018
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