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General NPI Number Information
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NPI Number | 1417907759
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Entity Type | Individual
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Provider Name | LEONARD MICHAEL MOSS MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 294 W STATE ROUTE 89A
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3754
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Country | US
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Telephone | 928-639-6382
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Fax | 928-639-5570
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Provider Business Mailing Address
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Address Line | 1200 N BEAVER ST PAYER CREDENTIALING
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-773-2559
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Fax | 928-213-6292
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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 | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 35331
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License Number State | AZ
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