Provider Demographics
NPI:1679778161
Name:MOSES, JAMES ETHAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ETHAN
Last Name:MOSES
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:1093 E BRIDGE ST
Mailing Address - Street 2:PEAK FORM MEDICAL CLINIC
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2252
Mailing Address - Country:US
Mailing Address - Phone:303-655-9005
Mailing Address - Fax:303-655-0063
Practice Address - Street 1:1093 E BRIDGE ST
Practice Address - Street 2:PEAK FORM MEDICAL CLINIC
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2252
Practice Address - Country:US
Practice Address - Phone:303-655-9005
Practice Address - Fax:303-655-0063
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2016-01-26
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Provider Licenses
StateLicense IDTaxonomies
CO497092083X0100X
OK25775208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine