Healthcare Provider Details

I. General information

NPI: 1639128317
Provider Name (Legal Business Name): MARK H MOSS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8633 BROADWAY ST SUITE 117
PEARLAND TX
77584-8497
US

IV. Provider business mailing address

3692 E SAM HOUSTON PKWY S SUITE 100
PASADENA TX
77505-3137
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-2988
  • Fax: 281-485-2337
Mailing address:
  • Phone: 713-946-1500
  • Fax: 713-946-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1645
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: