Provider Demographics
NPI:1902810344
Name:MOSS, JAMES B III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MOSS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:37 KENNEDY DR STE A
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1960
Mailing Address - Country:US
Mailing Address - Phone:860-963-7519
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:37 KENNEDY DR STE A
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1960
Practice Address - Country:US
Practice Address - Phone:860-963-7519
Practice Address - Fax:806-723-6532
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9693207RC0000X
CT70198207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125787505Medicaid
TX125787505Medicaid
TX8953B8Medicare PIN