Individual
AMY E MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2660
(817) 735-2299
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2660
(817) 735-2299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
K0350
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
K0350
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043663601
—
TX
01
—
380001166
RAILROAD MEDICARE
TX
01
—
83103G
BCBS
TX
Enumeration date
01/17/2006
Last updated
09/06/2011
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