Individual
JARED HARRIS MOSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
856 BANKS LOWMAN RD, GARDEN VALLEY, ID 83622-8102
(208) 462-3533
Mailing address
1752 E 2350 S, GOODING, ID 83330-5238
(307) 887-3975
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
06/03/2019
Last updated
06/03/2019
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