Individual
LARRY PATRICK MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
250 PARK ST, BOWLING GREEN, KY 42101-1760
(270) 745-1000
(270) 393-1913
Mailing address
350 PARK ST, BOWLING GREEN, KY 42101-1784
(270) 393-1912
(270) 393-1913
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1097968
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215853
BLUE CROSS
KY
05
—
3627422
—
TN
Enumeration date
03/08/2006
Last updated
10/11/2007
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