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General NPI Number Information
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NPI Number | 1376641027
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Entity Type | Organization
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Legal Business Name | WILLIAM E MOSS PSC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 4801 MANSLICK RD SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40216-4097
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Country | US
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Telephone | 502-366-0392
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Fax | 502-366-7086
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Provider Business Mailing Address
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Address Line | 4801 MANSLICK RD SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40216-4097
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Country | US
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Telephone | 502-366-0392
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Fax | 502-366-7086
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. WILLIAM E MOSS
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Credential | M.D.
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Telephone | 502-366-0392
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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 | 16800
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License Number State | KY
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