Provider Demographics
NPI:1679512990
Name:MOSS, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1528 CARRAWAY BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35234-1998
Mailing Address - Country:US
Mailing Address - Phone:205-250-6845
Mailing Address - Fax:205-250-6848
Practice Address - Street 1:644 TAHOE RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5028
Practice Address - Country:US
Practice Address - Phone:205-487-4224
Practice Address - Fax:205-487-3077
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-19
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Provider Licenses
StateLicense IDTaxonomies
AL8697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73793Medicare UPIN