Provider Demographics
NPI:1396852943
Name:FENBERG, MOSS JACOB (MD)
Entity type:Individual
Prefix:
First Name:MOSS
Middle Name:JACOB
Last Name:FENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1266 ESCALANTE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8934
Mailing Address - Country:US
Mailing Address - Phone:970-828-2200
Mailing Address - Fax:970-828-2201
Practice Address - Street 1:1266 ESCALANTE DR STE 301
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8934
Practice Address - Country:US
Practice Address - Phone:970-828-2200
Practice Address - Fax:970-828-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0618207WX0107X, 207W00000X
CO0050343207WX0107X
CO50343207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology