Provider Demographics
NPI:1124055876
Name:MOSES, STEPHEN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANDREW
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:430 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1614
Mailing Address - Country:US
Mailing Address - Phone:859-234-3282
Mailing Address - Fax:859-234-3778
Practice Address - Street 1:430 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1614
Practice Address - Country:US
Practice Address - Phone:859-234-3282
Practice Address - Fax:859-234-3778
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYTP521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40169OtherKY MEDICAL LICENSE
I26751Medicare UPIN