Individual
ALEX C MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
465 WASHINGTON ST, MONTPELIER, ID 83254-1544
(208) 847-2878
(208) 847-2340
Mailing address
465 WASHINGTON ST, MONTPELIER, ID 83254-1544
(208) 847-2878
(208) 847-2340
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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