Provider Demographics
NPI:1538151006
Name:MOSS, JOHN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2731 NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6913
Mailing Address - Country:US
Mailing Address - Phone:504-897-6351
Mailing Address - Fax:504-899-7317
Practice Address - Street 1:2731 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6913
Practice Address - Country:US
Practice Address - Phone:504-897-6351
Practice Address - Fax:504-899-7317
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013706207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1333026Medicaid
LA1333026Medicaid
D04116Medicare UPIN