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Individual
ALEX C MOSS
Active
Individual
ALEX C MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA516
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148620
BLUE SHIELD IDAHO INDIVID
ID
05
—
807007000
—
ID
01
—
8L568
BLUE CROSS IDAHO GROUP NO
ID
01
—
P00477878
MEDICARE RAILROAD
ID
01
—
PAWD7
BLUE CROSS OF IDAHO INDIV
ID
Enumeration date
10/23/2006
Last updated
06/19/2008
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