Individual
SANDRA DOTSON MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
290 OLD JACKSON HWY 31E, GLASGOW, KY 42141
(270) 678-5740
(270) 678-4701
Mailing address
290 OLD JACKSON HWY 31E, GLASGOW, KY 42141
(270) 678-5740
(270) 678-4701
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
19876
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045939
BCBS INDIVIDUAL NUMBER
KY
05
—
64198765
—
KY
Enumeration date
11/01/2006
Last updated
07/09/2007
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