Individual
DR. JOHN LAWRENCE MOSES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11803 SOUTH FREEWAY #203, FORT WORTH, TX 76115
(817) 568-1004
(817) 568-1040
Mailing address
11803 SOUTH FREEWAY #203, PO BOX 6337, FORT WORTH, TX 76115
(817) 568-1004
(817) 568-1040
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J7106
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040GG
BLUE CROSS BLUE SHIELD
TX
01
—
10028445
AMERIGROUP
TX
05
—
112008101
—
TX
Enumeration date
07/20/2006
Last updated
07/08/2007
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