Provider Demographics
NPI:1033511563
Name:MOSES, JESSE ALVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ALVIN
Last Name:MOSES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534-0130
Mailing Address - Country:US
Mailing Address - Phone:435-651-3700
Mailing Address - Fax:435-651-3376
Practice Address - Street 1:1478 EAST HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534-0130
Practice Address - Country:US
Practice Address - Phone:435-651-3700
Practice Address - Fax:435-678-0608
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT7852060-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant