Provider Demographics
NPI:1194470401
Name:MOSES, MICHAEL C JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:MOSES
Suffix:JR
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:16651 SOUTHWEST FWY STE 440
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2349
Mailing Address - Country:US
Mailing Address - Phone:346-874-2525
Mailing Address - Fax:346-874-2526
Practice Address - Street 1:16651 SOUTHWEST FWY STE 440
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2349
Practice Address - Country:US
Practice Address - Phone:346-874-2525
Practice Address - Fax:346-874-2526
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA17289363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant