NPI 1104455922 · live from the CMS NPI Registry
Tucker Jeppson, DO
Radiology, Diagnostic Radiology in Moscow, ID. National Provider Identifier 1104455922, active.
NPI record
| NPI | 1104455922 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 220 W 3rd St, Moscow, ID 83843 |
| Practice phone | 208-882-8369 |
| Mailing address | Po Box 9583, Moscow, ID 83843 |
| Enumerated | April 3, 2020 |
| Last updated | August 18, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology primary | 2085R0202X | 9861270 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.