Healthcare Provider Details

I. General information

NPI: 1043132772
Provider Name (Legal Business Name): JOSHUA AARON MOSES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E LOCKWOOD AVE
WEBSTER GROVES MO
63119-3141
US

IV. Provider business mailing address

470 E LOCKWOOD AVE
WEBSTER GROVES MO
63119-3141
US

V. Phone/Fax

Practice location:
  • Phone: 800-981-9801
  • Fax:
Mailing address:
  • Phone: 800-981-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2019021783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: