MEDICARE: DR. STEPHEN L MOSS D.P.M

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	213E00000X	Podiatrist	PO573	FL

General Provider Information

NPI Number	:	1588626493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN L MOSS D.P.M

Provider Business Mailing Address
First Line	:	6450 38TH AVE N
Second Line	:	310
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1645
Country	:	US
Telephone Number	:	727-347-8872
Fax Number	:	727-343-6670

Provider Business Practice Location Address
First Line	:	6450 38TH AVE N
Second Line	:	310
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1645
Country	:	US
Telephone Number	:	727-347-8872
Fax Number	:	727-343-6670

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	10/19/2007

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Directions to “ DR. STEPHEN L MOSS D.P.M” Practice Location

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