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NPI Code Detail

MEDICARE: JONATHAN BRENT MOSS M.D.

MEDICARE: JONATHAN BRENT MOSS M.D.
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
1208600000XSurgery Physician335264LA

General Provider Information

NPI Number : 1447784103
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BRENT MOSS M.D.
Provider Business Mailing Address
First Line : 728 W 11TH AVE
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2318
Country : US
Telephone Number : 985-892-3766
Fax Number :
Provider Business Practice Location Address
First Line : 728 W 11TH AVE
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2318
Country : US
Telephone Number : 985-892-3766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2017
Last Update Date : 03/04/2026

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