NPI 1205179751

Jacob Wayne Moss, MDJD

Practitioner General Practice Physician Saint Anthony, ID

Practice location

Address: 335 E Main St STE 1, Saint Anthony, ID 83445-1546
Phone: (208) 356-4900
Fax: (208) 624-4116
Mailing address: PO Box 18, Saint Anthony, ID 83445-0018

Registered specialties (2)

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence M-14547 (ID)

Other General Practice providers in Idaho →

General Practice Physician

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence TM190 (GA)

Registry record

NPI: 1205179751
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Apr 2013
Record last updated: 15 Oct 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.