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NPI Code Detail

MEDICARE: DR. JOHN ANTHONY MOSS D.O.

MEDICARE: DR. JOHN ANTHONY MOSS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0129XVascular Surgery PhysicianOS9710FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063411841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ANTHONY MOSS D.O.
Provider Business Mailing Address
First Line : 6821 PALISADES PARK CT STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-7131
Country : US
Telephone Number : 239-936-8555
Fax Number : 239-936-5611
Provider Business Practice Location Address
First Line : 6821 PALISADES PARK CT STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-7131
Country : US
Telephone Number : 239-936-8555
Fax Number : 239-936-5611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 11/05/2019

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