Provider Demographics
NPI:1770541146
Name:MOSER, FRANCIS BRYCE (DO)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:BRYCE
Last Name:MOSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1667
Mailing Address - Country:US
Mailing Address - Phone:208-785-2600
Mailing Address - Fax:208-785-8182
Practice Address - Street 1:1441 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1667
Practice Address - Country:US
Practice Address - Phone:208-785-2600
Practice Address - Fax:208-785-8185
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806641400Medicaid
ID000010143145OtherREGENCE BLUE SHIELD
ID313054OtherALTIUS
IDS5593OtherBLUE CROSS OLD
IDH53741Medicare UPIN
ID000010143145OtherREGENCE BLUE SHIELD