Moffitt, Mitchell Jackson

Moffitt, Mitchell Jackson is an individual health care provider with primary practice located at 775 Pole Line Rd W Suite 111, Twin Falls ID 83301-5814. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Moffitt, Mitchell Jackson can be contacted via phone (208) 814-8000.

Contact Information

Primary practice address
775 Pole Line Rd W Suite 111 Twin Falls ID 83301-5814
Phone: (208) 814-8000
Fax: (208) 733-9402
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X M-10017 Idaho

Profile Details

NPI number 1093895229
LBN Legal business name Moffitt, Mitchell Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2006
Last updated Jan 7th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093895229 NPPES
Idaho MEDICAID 807839500

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