Individual provider · Type 1 NPI
Jacob Wayne Moss, MD, J.D.
General Practice Physician · St. Anthony, ID
NPI number
1205179751
Active
Practice location
335 E Main St Ste 1
St. Anthony, ID 83445-1546
Fax (208) 624-4116
Mailing address
PO Box 18
St. Anthony, ID 83445-0018
Other practice locations
- 3724 Woodking Dr Ste 1, Idaho Falls, ID 83404 · (208) 356-4900
- 72 S 1st E Ste 101, Rexburg, ID 83440-1902 · (208) 356-4900
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| General Practice Physician Primary | 208D00000X | M-14547 (ID) |
| General Practice Physician | 208D00000X | TM190 (GA) |
General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
8 other providers at this address
- Upper Valley Community Health Services IncFederally Qualified Health Center (FQHC) St. Anthony, ID NPI 1972792489
- Amberly Guymon, LMSWSocial Worker St. Anthony, ID NPI 1386539112
- Andrew Logan Brower, PA-CPhysician Assistant St. Anthony, ID NPI 1760766976
- Bryce David Wylie, PA-CPhysician Assistant St. Anthony, ID NPI 1811043862
- Larry Miles Bradley, LCSWClinical Social Worker St. Anthony, ID NPI 1891139432
- Ryan G. Willmore, PA-CPhysician Assistant St. Anthony, ID NPI 1750840138
- Trevor Glade Wilde, DOFamily Medicine Physician St. Anthony, ID NPI 1538422019
- Whittney Kay Miller, FNP-CFamily Nurse Practitioner St. Anthony, ID NPI 1467880773
Other general practice physician providers in St. Anthony
About NPI 1205179751
Jacob Wayne Moss, MD, J.D.'s National Provider Identifier is 1205179751, issued on Apr 3, 2013. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in St. Anthony, ID. The record was last updated on Oct 15, 2025.