Healthcare Provider Details

I. General information

NPI: 1497750970
Provider Name (Legal Business Name): JAMES LUNDY MOSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 BERT KOUNS
SHREVEPORT LA
71106
US

IV. Provider business mailing address

255 BERT KOUNS LOOP
SHREVEPORT LA
71106-8150
US

V. Phone/Fax

Practice location:
  • Phone: 318-683-0411
  • Fax: 318-603-5461
Mailing address:
  • Phone: 318-683-0411
  • Fax: 318-603-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number013320
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: