Healthcare Provider Details

I. General information

NPI: 1104450816
Provider Name (Legal Business Name): PAUL ISAIAH MOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVY BRANCH HEALTH CLINIC SOUDA BAY, PSC 814 BOX 19
FPO AE
09865
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 282-102-1590
  • Fax:
Mailing address:
  • Phone: 937-542-1524
  • Fax: 571-231-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101273109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: