Healthcare Provider Details

I. General information

NPI: 1689630659
Provider Name (Legal Business Name): MOSES MUZQUIZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/28/2010
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 TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301026718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: