Provider Demographics
NPI:1790675429
Name:MOFFETT, ISAAC B
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:B
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-0384
Mailing Address - Country:US
Mailing Address - Phone:208-608-3998
Mailing Address - Fax:
Practice Address - Street 1:1160 E 3600 N
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-6202
Practice Address - Country:US
Practice Address - Phone:208-608-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)