Provider Demographics
NPI:1578509212
Name:MORSE, JEREMY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:C
Last Name:MORSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2349
Practice Address - Street 1:15622 N HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8710
Practice Address - Country:US
Practice Address - Phone:208-687-4878
Practice Address - Fax:208-687-4879
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10900207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1578509212Medicaid
WY123366100Medicaid
WY611665901OtherDEPT OF LABOR
WY611665901OtherDEPT OF LABOR
WY315273OtherBC/BS
WYP00350523Medicare PIN