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General NPI Number Information
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NPI Number | 1639290976
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Entity Type | Individual
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Provider Name | PERCY CLEOPHUS MOSS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 3435 W VAN BUREN ST SUITE A
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City | CHICAGO
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State | IL
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Zip | 60624-3312
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Country | US
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Telephone | 773-722-0013
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Fax | 312-226-2258
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Provider Business Mailing Address
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Address Line | 864 S LAFLIN ST
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City | CHICAGO
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State | IL
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Zip | 60607-4026
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Country | US
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Telephone | 312-666-2455
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Fax | 312-226-2258
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 3643944
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License Number State | IL
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