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General NPI Number Information
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NPI Number | 1114584125
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Entity Type | Organization
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Legal Business Name | MOSS RESTORATIVE FOOT & ANKLE CENTER, PLLC
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 7855 38TH AVE N STE 200
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1134
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Country | US
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Telephone | 727-302-9500
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Fax | 949-404-8237
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Provider Business Mailing Address
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Address Line | PO BOX 40002
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City | ST PETERSBURG
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State | FL
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Zip | 33743-0002
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Country | US
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Telephone | 727-302-9500
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Fax | 949-404-8237
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. DOUGLAS BRIAN MOSS
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Credential | DPM
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Telephone | 727-641-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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