Provider Demographics
NPI:1174567804
Name:MOSS, ROBERT EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:MOSS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:913 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:VA ROSEBURG HCS
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6523
Mailing Address - Country:US
Mailing Address - Phone:541-440-1000
Mailing Address - Fax:541-677-3150
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:VA ROSEBURG/SPECIALTY CLINIC
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6523
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:541-677-3150
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-04-25
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Provider Licenses
StateLicense IDTaxonomies
ORMD162031208M00000X
WAMD00038999207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist