Provider Demographics
NPI:1215257399
Name:CHARLES R MOSES MD PA
Entity type:Organization
Organization Name:CHARLES R MOSES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-729-3294
Mailing Address - Street 1:7980 ANCHOR DR
Mailing Address - Street 2:STE #1100
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8266
Mailing Address - Country:US
Mailing Address - Phone:409-729-3294
Mailing Address - Fax:409-729-9076
Practice Address - Street 1:7980 ANCHOR DR
Practice Address - Street 2:STE #1100
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8266
Practice Address - Country:US
Practice Address - Phone:409-729-3294
Practice Address - Fax:409-729-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1487207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty