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Mr. Jacob Wayne Moss, MD,JD
General Practice Physician in Driggs, Idaho
NPI 1205179751

Jacob Wayne Moss is a General Practice Physician based in Rexburg, ID. Jacob Wayne Moss practices in Driggs, ID and has the professional credentials of MD,JD. The NPI Number for Jacob Wayne Moss is 1205179751 and holds a License No. TM190 (Idaho).

The current practice location address for Jacob Wayne Moss is 283 N 1St St, Driggs, ID and can be reached out via phone at 208-354-2302 and via fax at 208-354-8392.

Location: 283 N 1St St, Driggs, ID, 83440-2210
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1205179751
Provider Name
Jacob Wayne Moss
Credential
MD,JD
Provider Entity Type
Individual
Gender
Male
Address
283 N 1St St, Driggs, ID, 83440-2210
Phone Number
208-354-2302
Fax Number
208-354-8392
Provider Enumeration Date
04/03/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
283 N 1St St
City
Driggs
State
Idaho
Zip
83422-5109
Phone Number
208-354-2302
Fax Number
208-354-8392
person
Provider Business Mailing Address Details
Address
283 N 1St St
City
Driggs
State
Idaho
Zip
83422-5109
Phone Number
208-354-2302
Fax Number
208-354-8392
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
TM190 (Georgia)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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