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General NPI Number Information
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NPI Number | 1447818521
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Entity Type | Individual
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Provider Name | JARED HARRIS MOSER PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 856 BANKS LOWMAN RD
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City | GARDEN VALLEY
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State | ID
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Zip | 83622-8102
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Country | US
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Telephone | 208-462-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 1752 E 2350 S
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City | GOODING
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State | ID
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Zip | 83330-5238
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Country | US
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Telephone | 307-887-3975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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