Provider Demographics
NPI:1063520583
Name:STEPHEN L. MOSS DPM PA
Entity type:Organization
Organization Name:STEPHEN L. MOSS DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-347-8872
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-347-8872
Mailing Address - Fax:727-343-6670
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SUITE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-347-8872
Practice Address - Fax:727-343-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH2915OtherRR MEDICARE
FL0742550001Medicare NSC
FL33038Medicare PIN