Provider Demographics
NPI:1285698662
Name:MOSS, ROGER B (CRNA)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:B
Last Name:MOSS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:823 SW MULVANE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1679
Mailing Address - Country:US
Mailing Address - Phone:785-235-3451
Mailing Address - Fax:785-235-1435
Practice Address - Street 1:823 SW MULVANE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1679
Practice Address - Country:US
Practice Address - Phone:785-235-3451
Practice Address - Fax:785-235-1435
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS54697367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100357700AMedicaid
KS145473OtherBCBS
KS100357700DMedicaid
KS145473OtherBCBS
KS145473Medicare PIN