MEDICARE: CLINT CAMERON 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	207N00000X	Dermatology Physician	P0769	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1578726352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINT CAMERON MOSS MD

Provider Business Mailing Address
First Line	:	815 PECAN GROVE RD E
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-1768
Country	:	US
Telephone Number	:	903-892-2126
Fax Number	:	903-892-2129

Provider Business Practice Location Address
First Line	:	815 PECAN GROVE RD E
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-1768
Country	:	US
Telephone Number	:	903-892-2126
Fax Number	:	903-992-2129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/26/2017

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