Healthcare Provider Details

I. General information

NPI: 1508193269
Provider Name (Legal Business Name): MOSES MUZQUIZ JR, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 LAURENCE AVENUE
JACKSON MI
49202
US

IV. Provider business mailing address

1041 LAURENCE AVENUE
JACKSON MI
49202
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-4111
  • Fax: 517-782-8869
Mailing address:
  • Phone: 517-787-4111
  • Fax: 517-782-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301026718
License Number StateMI

VIII. Authorized Official

Name: DR. MOSES MUZQUIZ JR.
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 517-787-4111