Individual
MR. JACOB WAYNE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., J.D.
Contact information
Practice address
335 E MAIN ST STE 1, SAINT ANTHONY, ID 83445-1546
(208) 356-4900
(208) 624-4116
Mailing address
PO BOX 18, SAINT ANTHONY, ID 83445-0018
(208) 356-4900
(208) 624-4112
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
M-14547
ID
208D00000X
General Practice Physician
TM190
GA
Other
Enumeration date
04/03/2013
Last updated
10/15/2025
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