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General NPI Number Information
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NPI Number | 1174567804
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Entity Type | Individual
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Provider Name | ROBERT EDWARD MOSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 913 NW GARDEN VALLEY BLVD VA ROSEBURG/SPECIALTY CLINIC
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City | ROSEBURG
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State | OR
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Zip | 97471-6523
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Country | US
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Telephone | 541-440-1000
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Fax | 541-677-3150
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Provider Business Mailing Address
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Address Line | 913 NW GARDEN VALLEY BLVD VA ROSEBURG HCS
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City | ROSEBURG
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State | OR
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Zip | 97471-6523
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Country | US
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Telephone | 541-440-1000
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Fax | 541-677-3150
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD162031
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD00038999
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License Number State | WA
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