MEDICARE: JOHN A MOSS MD

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
1	207Y00000X	Otolaryngology Physician	ME84424	FL

General Provider Information

NPI Number	:	1093100323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A MOSS MD

Provider Business Mailing Address
First Line	:	6230 SCOTT ST
Second Line	:	111
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3939
Country	:	US
Telephone Number	:	941-637-5780
Fax Number	:	941-627-5765

Provider Business Practice Location Address
First Line	:	6230 SCOTT ST
Second Line	:	111
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3939
Country	:	US
Telephone Number	:	941-637-5780
Fax Number	:	941-627-5765

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN A MOSS
Credential	:	MD
Telephone Number	:	941-637-5780

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	04/03/2015

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