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NPI Code Detail

MEDICARE: BRIAN W MOSS M.D.

MEDICARE: BRIAN W MOSS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianM-10302ID
2207P00000XEmergency Medicine PhysicianP3936TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033384201
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN W MOSS M.D.
Provider Business Mailing Address
First Line : 2965 S BERGMAN WAY
Second Line :
City : EAGLE
State : ID
Zip : 83616-4986
Country : US
Telephone Number : 208-949-8857
Fax Number :
Provider Business Practice Location Address
First Line : 1717 ARLINGTON AVE
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4802
Country : US
Telephone Number : 208-459-4641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2008
Last Update Date : 02/12/2026

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Directions to “ BRIAN W MOSS M.D.” Practice Location

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