| Doctor Name: | EZRA JOEL FOSS |
| NPI Number: | 1073877155 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 25237 |
| Business Practice Address: | 700 W Ironwood Dr Ste 214 Coeur D Alene, ID - 838144484 |
| Business Phone Number: | 2087580716 |
| Business Fax Number: | |
| Mailing Address: | 700 W Ironwood Dr Ste 214, COEUR D ALENE |
| State: | ID |
| Postal Code: | 838144484 |
| Phone Number: | 2087580716 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2012 |
| NPI Last Update Date: | 03/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 25237 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |