Provider Demographics
NPI:1104527720
Name:MOSS, ROBERT III
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MOSS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7499 STONETRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4240
Mailing Address - Country:US
Mailing Address - Phone:614-441-3118
Mailing Address - Fax:
Practice Address - Street 1:7499 STONETRAIL WAY
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4240
Practice Address - Country:US
Practice Address - Phone:614-441-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide