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General NPI Number Information
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NPI Number | 1144511700
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Entity Type | Individual
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Provider Name | DAVID R MOSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 1200 RIVERPLACE BLVD SUITE: 620
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9046
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Country | US
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Telephone | 904-396-6620
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Fax | 904-396-6528
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Provider Business Mailing Address
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Address Line | 1200 RIVERPLACE BLVD SUITE: 620
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City | JACKSONVILLE
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State | FL
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Zip | 32207-9046
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Country | US
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Telephone | 904-396-6620
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Fax | 904-396-6528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0045122
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME45122
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License Number State | FL
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