Provider Demographics
NPI:1649893637
Name:MOSES, ALEXANDER (PA-S)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:MOSES
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 BLUE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-8475
Mailing Address - Country:US
Mailing Address - Phone:509-720-1950
Mailing Address - Fax:
Practice Address - Street 1:1035 1ST AVE W STE 210
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5626
Practice Address - Country:US
Practice Address - Phone:406-607-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-116229363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program