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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093895229 | NPPES |
| Idaho | MEDICAID | 807839500 |
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