Provider Demographics
NPI:1659471035
Name:MOSES, BERNARD C (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:C
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 S HWY 25 W
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769
Mailing Address - Country:US
Mailing Address - Phone:606-549-5052
Mailing Address - Fax:606-549-2718
Practice Address - Street 1:686 S HWY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-549-5052
Practice Address - Fax:606-549-2718
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64191299Medicaid
KY1152301Medicare ID - Type Unspecified
KY64191299Medicaid