Individual
DR. TIMOTHY ALAN MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 REDSTONE AVE W STE 370, CRESTVIEW, FL 32536-6429
(850) 423-9976
(850) 306-3767
Mailing address
550 REDSTONE AVE W STE 370, CRESTVIEW, FL 32536-6429
(850) 423-9976
(850) 306-3767
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
17208
SC
208800000X
Urology Physician
9500670
NC
208800000X
Urology Physician
Primary
ME144367
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110W
BLUE CROSS BLUE SHIELD
NC
01
—
340013661
RAILROAD MEDICARE
NC
05
—
790110W
—
NC
05
—
8960187
—
NC
Enumeration date
03/24/2006
Last updated
07/10/2023
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