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General NPI Number Information
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NPI Number | 1447241781
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Entity Type | Individual
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Provider Name | KENNETH WAYNE MOSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 1901 VETERANS MEMORIAL DRIVE, NEUROLOGY SECTION CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM
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City | TEMPLE
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State | TX
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Zip | 76504-7451
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Country | US
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Telephone | 254-721-6105
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Fax | 254-743-0132
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Provider Business Mailing Address
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Address Line | 1901 VETERANS MEMORIAL DRIVE, NEUROLOGY SECTION CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM
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City | TEMPLE
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State | TX
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Zip | 76504-7451
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Country | US
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Telephone | 254-721-6105
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Fax | 254-743-0132
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0036402
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License Number State | NC
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