Individual
DR. GORDON M MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30840 NORTHWESTERN HWY, SUITE 300, FARMINGTON HILLS, MI 48334-2552
(248) 932-1250
(248) 932-8977
Mailing address
30840 NORTHWESTERN HWY, SUITE 300, FARMINGTON HILLS, MI 48334-2552
(248) 932-1250
(248) 932-8977
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301035695
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639154925
—
MI
01
—
700F319250
BLUE SHIELD
MI
Enumeration date
12/09/2005
Last updated
07/15/2011
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