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General NPI Number Information
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NPI Number | 1689630659
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Entity Type | Individual
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Provider Name | MOSES MUZQUIZ JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 1041 LAURENCE AVENUE
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City | JACKSON
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State | MI
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Zip | 49202
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Country | US
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Telephone | 517-787-4111
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Fax | 517-782-8869
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Provider Business Mailing Address
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Address Line | 1041 LAURENCE AVENUE
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City | JACKSON
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State | MI
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Zip | 49202
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Country | US
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Telephone | 517-787-4111
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Fax | 517-782-8869
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301026718
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License Number State | MI
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